CP Placenta Previa

ACKNOWLEDGEMENT
This project would not be made possible without the help and guidance of
our Almighty Father, who conveyed our group adequate knowledge, sufficient
vigor and bravery to face innovative and peculiar defy during the entire course of
this project. Our never-ending thanks to Almighty Father the most High for the
love and care he showered upon us.
Our genuine gratitude to our beloved parents for always supporting us

physically, mentally, emotionally and financially in regards to this venture.
Warmth thanks for entrusting to us their confidence and understanding not only
in times of need but in everyday of our lives. They used to complain that we are
getting too sovereign and matured; however we live in the ideology that letting go
of their children is the hardest part of being a parent. Though it is not easy for us
to acknowledge the fact that we are getting old bit by bit, we have to separate
from them in order to understand the true essence of being a human, and still our
love for them remains the same. To our dear parents, rest guaranteed that what
we are doing right now will serve as a stepping stone towards a philosophical
future and sagacious life, and that is being a nurse.
Likewise, the group would like to express our appreciation to the members
and staff of the Obstetrical Ward and the midwives of the Birthing Home of
Davao Medical Center, for allowing us to choose our case study from their
respected institution.
To our adored mentors and clinical instructors especially Mrs. Aurea

Llamido and Mrs. Mary Jean Tulas, thank you so much for everything. Thank you
for the patience, in spite of our unfathomable enthusiasm in talking, for the
camaraderie founded based on accepting individuals discrepancy and all the
things that you’ve taught us. We’ve learn many possessions from you our dear
teachers. And for this words will not be enough to express our gratefulness.
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Friends and classmates, we are delighted of how thoughtful you all are in
sharing one school year. Thank you for giving out your insights, knowledge and
ideas that helped a lot in putting this assignment, this case presentation a
comprehensive one.
Lastly, to the special people behind this project, this is not the end of the
world yet… We still have more case presentation waiting ahead of us and this
may serve a new beginning and a stepping stone for more decisive case
presentations in our higher year.
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INTRODUCTION
Pregnancy is an exciting time in any parent's life. It's a time of change,
growth, discovery and a lot of questions. One of the most important factors of
having a healthy baby is the mother’s health especially during the 9 months
where the child’s development has already started. The mother’s nutrition,
activity etc. greatly affect the developing fetus inside her womb such that any
move could put the child at risk resulting to abnormalities, poor health or even
death to the precious being anytime or even during pregnancy if mother’s health
is being taken for granted.
Complications may occur at any time during pregnancy and can result
from pre-existing maternal medical problems or from the pregnancy itself. Early
and consistent prenatal care results in improved fetal and maternal
outcomes, regardless of complications that may occur.
One of these complications, placenta previa, is a condition in which the
placenta is implanted close to or covers the cervical os. Normally, the placenta
implants in the upper uterine segment, but in the case of placenta previa, the
placenta implants in the lower part of the uterus.
Placenta previa is experienced in 1 out of 200 pregnancies around the
world. Maternal morbidity rate is approximately 5% and mortality rate is less than
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1%. In the Philippines , it reached to 6,341 out of the 86,241,697 population
estimate used in the year 2004. The mortality rate of placenta previa in the
country is 0.17% according to DOH, Davao as of 2007. While mortality rate in the
locality of Davao is 0% as of 2007.
During our duty in the Ob ward at Davao Medical Center , we decided to
take the case of Ms. Skema 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. For the community, we hope that this will
increase the level of awareness among the members of the community so that it
could help in the prevention of further pregnancy complications.
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OBJECTIVES
General
This case study aims that the students and the readers will gain
knowledge and further understanding about Placenta Previa.
Specific
To be able to:
1. Establish rapport with our client including her family members
2. Gather all necessary information regarding her and her family members as
may be related to our case study
3. Ascertain client’s past and present health history
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
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14. Render health teachings as part of our holistic care to alleviate problems
identified
15. Evaluate complications to nursing practice, education and research
PATIENT’S DATA
Name: Skema
Address: Purok 3, Durian Street, Tugbok, Davao City
Age: 23 y.o.
Birthday: October 05, 1984
Birthplace: Davao City
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: First Year College, Mass Communication
Occupation: Housekeeper
Spouse: None
Date Admitted: August 30, 2008
Time Admitted: 6:10 am
Ward: OB
Bed no.: 22
Admitting Diagnosis: Pregnancy uterine 37 3/7 weeks AOG, G2P1,
Placenta Previa Totalis
Final Diagnosis: Pregnancy uterine cephalic delivered term baby boy
livebirth via low segment transverse cesarean section;
Placenta Previa Totalis G2P2 (2002)
Admitting Doctor: Dr. Brana, Analita V.
Consultant Doctor: Dr. Ayunan
Admitting Clerk: Mallwat, Carmelita C.
Attending Physician: Manual Aries, MD
Herrera Eustaquio, MD
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HEALTH HISTORY
Family Health History
The patient's grandfather on her mother's side, Bernardeno, died due to

old age and her grandmother, Teofila, died of because of asthma. Her father,
Paulino, died in the year 1996 due to hypertension while her mother, Evangeline,
is still alive and doesn't experience any serious illness at present. Skema has
three siblings and all of them are still alive except for the youngest of them,
Barry, who died in the car accident. Her elder sister Hazel has hypertension while
her younger brothers, Glenn Paul, have vices, which include smoking and
drinking alcohol.
On the other hand, the patient's grandfather on her father's side died of
hypertension.
The patient is the 2nd child in the family. She’s still single but living with
Jaguar (her partner) for 3 years now, and they are currently living at P3, Durian
St., Tugbok (POB), Davao City. They are what we call as “cohabiting” family.
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. Jaguar goes to work at 7
am and come home late in the afternoon while Skema stays at home and do the
household chores and take care of Trisha Mae (their first child). The patient
doesn't drink alcohol and doesn't even smoke.
History of Past Illness
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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 first pregnancy.
Obstetrical History
Upon interview, the patient told us that her menarche started at the age of
13, irregular, with 1 – 2 months interval. Her menstrual period usually lasts from 5
days and she could use up 2 napkins per day. She can’t remember the date
when her last menstrual period of her first baby. She only tells us that her first
baby is a girl and she delivers her baby through normal spontaneous vaginal
delivery last 2005 and she also said that there are no complications occur. On
her second pregnancy the patient also told us that her last menstrual period was
on December 10, 2007.
The patient told us that she never used any contraceptive ever since and
all the babies are all planned.
History of Present Illness
The patient verbalized that it was her second pregnancy. Her last
menstrual period for her second pregnancy was on December 10, 2007. She has
her prenatal check-up at Rusiana lying-in. 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 September 17, 2008, with
the age of gestation of 37 3/7 weeks. When August 30, 2008 arrived, she had the
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chief complaint of having a vaginal bleeding, so she was confine immediately and
it was then the placenta overlap the entirety of the cervical os.
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GENOGRAM
Mother’s Side Father’s Side
Bernardeno Teofila Francisco Ely

╬ ♫╬ ↑╬
Delia Evangeline Gloria Bernard Libeth Paulino Regina Teofredo

♫ ♫ ↑╬ ↑
Hazel Skema Glenn Paul Barry

↑ Ω ╬
Legend: Ω - Placenta Previa ♫ - asthma ↑ - hypertension

╬ - Deceased
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Developmental Data
Theorist Theory Developmental Task Result and Justification

Robert Developmental Task Theory, She is 23 years old. She
Havighurst based on learning and learned belongs in the early adulthood
behaviors, called developmental from 20 to 40 years of age. The
tasks that emanate from developmental tasks of our
biologic, psychological and client are to select a mate, learn
social origins during lifespan. to live with a partner, start a
Specific developmental tasks family, rear children, manage a
are assigned to the various home, get started in an
stages of life. Failure to occupation, take on civic
complete the tasks assigned to responsibility and find a
each stage may lead to failure in congenial social group.
1. Selecting a life partner She has achieved this because she
tasks in subsequent stages.
According to this theory, √ has a guy who lives with her and
success in achieving the considers him as a husband.
Developmental tasks leads to
success with tasks in later
stages of life.
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2. Learning to live with a partner √ She has achieved this because she
lives with her “husband” for almost 4
years. They where not married at all
but all the time she considers him as
her husband.
She and her partner have already a

3. Starting a family √ daughter which is already 3 years old
and now a new son. Both of there
children were planned according to
them.
She has achieved this task. She takes

4. Rearing children √ care of her children. Her eldest is
Trisha Mae, as she grows; she was
also taught with good moral values at
home even at a young age. Also she
takes care of her in any way she could.
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5. Managing a home She and her partner have a house of
their own. They do not live in the same
√ roof with their parents. She is able to
organize their home effectively. The
money that her husband gets is equally
distributed to them.
6. Getting started in an She has achieved this task. She was a

occupation √ cashier on a grocery store near there
place; but now, she retired and took
the responsibility of being a housewife.
7. Taking on civic responsibility She votes during election period. She

√ is also concerned of the crisis that is
happening today especially the
increasing prices of goods.
8. Finding a congenial social √ She achieved this because she joins

group the activities in there community like
Barangay health programs.
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Erik Erikson envisions life as a She belongs to Eric Erikson’s She has achieved this stage which is
Erickson sequence of levels of stage of Intimacy vs. Isolation. It √ intimacy, because she learned how to
achievement. Each stage is from 20 to 25 years of age. love. And so their love brought them
signals a task that must be
Trisha Mae and now a new son. Even
achieved. The resolution of a In Young adulthood, we begin
though they are not married, they still
task can be complete, partial, or to share ourselves more
consider themselves married because
unsuccessful. Erikson believes intimately with others. We
the way they love each other is like the
that the greater the task explore relationships leading
achievement, the healthier the toward longer term
love you can find in married couples.
personality of the person; failure commitments with someone

to achieve a task influences the other than a family member.
person’s ability to achieve the Successful completion can lead
next task. Erikson’s eight stages to comfortable relationships and
reflect both positive and a sense of commitment, safety,
negative aspects of the critical and care within a relationship.
life periods. The resolution of Avoiding intimacy, fearing
the conflicts at each stage commitment and relationships
enables the person to function can lead to isolation, loneliness,
effectively in the society. and sometimes depression.
Lawrence Kohlberg’s model states that a Her age correlates to the post- She understands what laws are for and
Kohlberg person’s ability to made moral conventional level. √ their purpose. And so she knows what is
judgments and behave in a right and what is wrong. When talking
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morally correct manner develops The individual makes a clear about abortion, she told us that it is really
over a period of time and effort to define moral values not right to abort a baby because it’s
progresses in relationship to and principles that have validity against the law and it’s really considered a
cognitive development. and application apart from the sin because you kill someone’s life.
authority of the groups of
persons holding them and apart
from the individual's own
identification with the group.
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DEFINITION OF COMPLETE DIAGNOSIS
PLACENTA PREVIA TOTALIS
• 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.
Source:
http://www.answers.com/topic/caesarean-section
• Low Segment Transverse Cesarean Section - Incision made horizontally

across the lower end of the uterus; this kind of incision is preferred for less
bleeding and stronger healing.
Source:
http://www.answers.com/topic/low-transverse-incision
• Low Segment Transverse Cesarean Section - the incision is made

horizontally across the lower uterine segment.
Source:
http://www.encyclopedia.com/doc/1G2-3447200117.html
• Placenta previa - is an obstetric complication in which the placenta has

attached to the uterine wall close to or covering the cervix. It can some
times occur in the latter part of the first trimester, but usually during the
second or third. It is a leading cause of antepartum hemorrhage (vaginal
bleeding).
Source:
http://en.wikipedia.org/wiki/Placenta_previa
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• Placenta previa - is defined as implantation of the placenta in the lower
uterine segment in advance of the fetal presenting part.
Source: http://www.womenshealthsection.com/content/print.php3?
title=obs018&cat=2&lng=english
• Placenta previa is an obstetric complication that occurs in the second and

third trimesters of pregnancy.
Source:
http://www.emedicine.com/emerg/topic427.htm
• Complete placenta previa - is where the placenta completely covers the

internal os.
Source: http://www.womenshealthsection.com/content/print.php3?
title=obs018&cat=2&lng=english
• 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.
• Total placenta previa - covers and blocks the cervical opening

Source:
http://www.webmd.com/content/article/13/3608_263
PHYSICAL ASSESSMENT
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General Survey
We received Mrs.Skema, 23 years of age, 5’2’’ tall, weighing 55kg, 2

days post-partum, was assessed on September 1, 2008 at Davao Medical
Center, OB ward at bed no22. The client was conscious, alert, coherent,
cooperative and oriented to time, place, person and her surroundings. No IVF
line. She is mesomorphic built. Facial grimace and abdominal guarding were
noted.
Vital Signs
Shift: 11-7
T : 36.5C
PR : 86bpm
RR : 22bpm
BP : 80/60
Skin
Client has brown complexion. Skin is smooth, moist, warm to touch and
has a good turgor. Capillary refill time of 2 seconds. Skin integrity was no longer
intact due to a lesion on the right lower leg and a horizontal or transverse
cesarean incision made through the maternal abdomen. Bleeding and bruises
were not seen upon observation.
Head
The head configuration is normocephalic. Facial movements are

symmetrical. The hair color is black, long, oily and evenly distributed over the
scalp. There were no signs of dandruff. No swelling, lacerations, bruises and
tenderness was seen upon inspection.
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Eye
The eyelids are symmetrical with each other. Conjunctiva is pink and the
cornea is moist and white in color and lacrimal apparatus is present on both
eyes. The iris appears to be black on both eyes. With 2 mm size pupils, equally
round and briskly reactive to light and accommodation. Eyebrows are thin and
eyelashes are evenly distributed along the margin of the eyelids and visual acuity
is grossly normal. There were no lesions and unusual secretions observed.
Ears
The external pinnae are symmetrical. The gross hearing is also

symmetrical. Upper margin of the pinnae is in line with the outer canthus of the
eyes. No signs of lesions and bruises were seen upon observation. There were
no foul smelling and purulent discharges noted in the external canal.
Nose
External surface of the nose was oily and pimples were noted. Nasolabial
folds were not flaring and nasal septum is in the midline of the head. Nasal
mucosa is moist, pinkish and nasal hair is present.. Air patency is good. Gross
smell is symmetrical. No foul discharges, lesions or masses were noted.
Mouth
Lips are pale, slightly dry and without lesions. Mucosa is pinkish red,
smooth and moist. The tongue is midline position and tonsils are not inflamed.
Teeth are not complete, upper and lower right canine were missing with chalky
white discoloration of the enamel. Upper front teeth were replaced by false
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dentures. Gums are pinkish and there were no signs of swelling, bleeding, and
lesions. On soft diet with good appetite.
Neck
Neck can move easily without any discomfort which includes right and left
lateral, right and left rotation, flexion and hyperextension. Trachea is located
midline with no deviation upon palpation. Carotid pulse is palpable.. Lymph
nodes in the neck are not enlarged. No rigid and masses or any deformities are
noted.
Chest and Lungs
Shape of chest is normal and with symmetrical lung expansion. Thorax is

symmetrical. Respiratory rate is 22 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 and difficulty in breathing. Breath
sounds is clear and heard almost of all of anterior lungs upon auscultation.
Heart
The apical pulse is auscultated at the left midclavicular line, fifth

intercostals space. The cardiac sounds were regular and are not difficult to
auscultate, in which the cardiac rate was 84 beats per minute.
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
palpated.
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Abdomen
Has soft, globular, non-distended abdomen. Horizontal (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. Stretch marks and linea nigra were evident upon inspection.
Normoactive sounds heard upon ausculattion. Facial grimacing and abdominal
guarding noted upon palpation of abdomen, also when client moves.
GenitoUrinary
Client can urinate properly without difficulties and without any assistance.
Client was using a diaper.
Upper Extremities
Upper are bilaterally symmetrical. Both arms can strech, flex, rotate and
extend without difficulty. Handgrip was strong. No signs of lesions and bruises
noted. Fingernails were not trimmed and were dirty. Peripheral pulses of the
client are symmetrical with regular and strong pulsation.
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. Lessions on the right lower leg was noted. Toenails were untrimmed.
Deformities, bleeding and bruises were not noted.
ANATOMY AND PHYSIOLOGY
OF THE
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FEMALE REPRODUCTIVE SYSTEM
Internal Structure
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Vagina
The vagina is a hollow musculomembranous canal located posterior to the

bladder and anterior to the rectum. 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 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.
Ovaries
The ovaries are grayish-white and appear pitted or with minute

indentations on the surface. An unruptured, glistening, clear, fluid-filled graafian
follicle (an ovum about to be discharged) or miniatured yellow corpus luteum
often can be observed on the surface of the ovary. 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.
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Fallopian Tube
These are narrow tubes that are attached to the upper part of the uterus
and serve as tunnels for the ova (egg cells) to travel from the ovaries to the
uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the
fallopian tubes. The fertilized egg then moves to the uterus, where it implants to
the uterine wall.
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 mmaturity 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 accomodating 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
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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 ther external os is at the level of the ischial spines.
Pelvis
The pelvis serves both to support and protect the reproductive and other
pelvic organs. It is a bony ring formed by four united bones; the two innominate
bones which formed the anterior and lateral portion of the ring, and the coccix
and sacrum, which form the posterior aspects. Each innominate bone is divided
into three parts: ilium, ischium and the pubis. The ilium forms the upper and
lateral portion. The flaring superior border of these bones is what forms the
prominence of the hip. The ischium is the inferior portion. At the lowest portion of
the ischium are two projections; the ischial tuberosites. This is the portion of bone
on which a person sits. These projections are important markers used to
determine lower pelvic grid. Other important terms in relation the pelvis are the
inlet, the pelvic cavity and the outlet. The inlet is the entrance to the true pelvis or
the upper ring of bone through which the fetus must pass to be born vaginally. It
is at the level of the linea terminalis or is marked by the sacral prominence in the
back. The ilium of the sides and the superior aspects of the symphisis pubis is in
the front. If one looks down at the pelvic inlet, the passageway at this point
appears heart-shaped because of the jutting sacral prominence. It is wider
transversely than in the anteroposterior dimension. The outlet is the inferior
portion of the pelvis, or the portion bounded in the back of the coccyx, at the
sided by the ischial tuberositis and in front by the inferior aspect of the symphysis
pubis. In contrast to the inlet of the pelvis, the greatest diameter of the outlet is its
anteroposterior diameter. For the baby to be delivered vaginally, he or she must
be able to pass through the inlet, the cavity and the outlet of the pelvic bone. This
is not a problem for an average fetus; it may be a problem if a mother is a young
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adolescent who has not yet achieved full pelvic growth or a woman who has not
had an injury.
Placenta
Organ that develops in the uterus during pregnancy. It is a unique

characteristic of the higher (or placental) mammals. In humans it is a thick mass,
about 7 in. (18 cm) in diameter, liberally supplied with blood vessels. The
placenta is attached to the uterus, and the fetus is connected to the placenta by
the umbilical cord. The placenta draws nourishment and oxygen, which it
supplies to the fetus, from the maternal circulation. In turn, the placenta receives
the wastes of fetal metabolism and discharges them into the maternal circulation
for disposal. There are 15-20 cotyledons found in the placenta.
External Structure
Mons Veneris
The mons veneris is a pad of adipose tissue located over the symphisis
pubis, the pubic bone joint. It is covered by a triangle of coarse, curly hairs. Its
purpose is to protect the pubic bone from trauma.
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Labia Majora
The labia majora are two fold of adipose tissue covered by loose
connective tissue and epithelium; they are positioned later to the labia minora.
Covered by pubic hair, the labia majora serves as a protection for the external
genitalia and the distal urethra and vagina.
Labia Minora
It is located posterior to the mons veneris spread two hairless fold of

connective tissue. Before the menarche, these folds are fairly small; by
childbearing age, they are firm and full; after menopause they atrophy and again
they become smaller.
Clitoris
The clitoris is a small rounded organ of erectile tissue at the forward

junction of the labia minora. It is covered by fold of skin known as the prepuce. It
is sensitive to touch and temperature and is the center of sexual arousal and
orgasm in the female. When the ischiocavernosus muscle surrounding it
contracts with sexual arousal, the venous outflow for the clitoris is blocked
leading to clitoral erection.
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ETIOLOGY
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Predisposing
Factors Remarks Rationale Justification
Age x Women older than This is not applicable to

30 years are 3 times our patient since her age
more likely to have is 23 years old.
placenta previa than
women younger than
20 years
Family history of / Having a family According to the patient’s

Hypertension member or relative family background, her
who had family or relatives does
experienced is a risk have a hypertension.
factor for having
placenta previa
Race / Importance of race is Our patient is a Filipino

fairly debatable. woman so this factor is
several studies considered to be
propose an contributory to her
increased risk of condition.
placenta previa
among African
Americans and
Asians, whereas
other studies
mention no
discrepancy.
Gender / Only pregnant Our patient is a women

women can and she can have the risk
experience this of having placenta previa
condition.
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Precipitating
Factors Remarks Rationale Justification
SYMPTOMATOLOGY
SYMPTOMS RATIONALE
Occurs after 20weeks of / The placenta in this stage is well

gestation developed or matured and needed
more blood supply, so it migrates
to a more vascularized part of the
uterus.
Bleeding, bright red in color / This bleeding, bright red in color, is

associated with the stretching and
thinning of the lower uterine
segment that occurs during the
third trimester.
30
Painless vaginal bleeding / The uterus is not able to
adequately contract and stop blood
flow from open vessels.
31
Precipitating Factors:
Predisposing Factors:
Race  Second
Gender Pregnancy
 Male fetus
Increase in
progesterone and
estrogen levels
Pre-
embryonic
Stage
Fertilization of
sperm and
ovum
Reproduction
of a fertilized
ovum (zygote)
Implantation of
blastocyst to
the uterine
endometrium
32
Embryonic Stage
The placenta
arises out of the
trophoblast
tissue
low-lying placenta
should move away from
the cervix and out of the
lower uterine segment
Insufficient blood
supply in the placenta
Migrates to where
there is sufficient blood
supply
Placenta resides in the

lower uterine segment
33
Implantation totally
Total Placenta obstruct the cervical os
Previa
Profuse Painless Hypotension

bright-red vaginal
bleeding bleeding
Hypovolemic
Shock
34
Medical assistance
Treated Cesarean section during Untreated
labor and delivery
Medications to prevent
uterine contractions
Birth defects
Good Prognosis Premature delivery
Anemia
Infection
FDIU
Abnormal placental
If treated, there will be good attachments
maternal vital signs and the fetus
will be delivered successfully
without complications
35
PATHOPHYSIOLOGY
(Narrative)
During pregnancy, your placenta repositions itself as your uterus stretches

and grows. In early pregnancy, a low-lying placenta is very common. But as your
pregnancy progresses, the enlarging uterus should "pull" the placenta toward the
top of your uterus. By your third trimester, the placenta should be near the top of
your uterus, leaving the opening of the cervix clear for the delivery.
Placenta previa typically occurs as a result of abnormally low implantation.

Although no specific cause has been identified to date, this condition has been
hypothesized to occur as a result of abnormal endometrial vascularization related
to atrophy or scarring from prior trauma or inflammation.
As the lower uterine segment thins in late pregnancy, the margins of the
abnormally implanted placenta are altered. Various degrees of placental
detachment may develop, with ensuing maternal hemorrhage from the
intervillous space. During labor, significant fetal hemorrhage also can occur as a
result of disrupted villous placental vessels.
Risk factors for placenta previa include prior placenta previa, prior
cesarean delivery, increased maternal age, large placentae (eg, multiple
gestations or erythroblastosis), and a maternal history of smoking.
If untreated, it may lead to severe maternal hemorrhage, premature

delivery, and birth defects and the like.
If this is treated, there will be a good prognosis
36
DOCTOR’S ORDER
DATE ORDER RATIONALE REMARKS

08-30-08 * Please admit * For legal purposes DONE
6:10am
* To prevent aspiration DONE
* NPO
during the procedure.
* Vsq4
* To have baseline data. DONE
* Labs :
*Laboratory test help
determine clients general DONE
- CBC
health status.
- UA DONE
* CBC identifies the total
- HBsAg
number of white blood
- BT
cell and red blood cell,
the platelet count, and
hemoglobin and
hematocrit.
* UA a test to detect DONE
semi-quantitatively
measures various
compounds that are
eliminated in the urine.
* HBsAg is a test to
examine if patient is DONE
immune from acquiring
hepatitis B.
* BT is a test to DONE
determine if what ABO
blood group and Rh
factor status the patient
belong.
37
* IV administration is
DONE
* Start Venoclysis with D5lR 1L @ performed to replace
120cc/hr fluids, administer
medications and to
provide water and
electrolyte.
* Signed consent
* Secure Consent ensures that the patient DONE
is properly informed
regarding the process,
risks, and possible
complications of the
procedures and is not
forced to coerce to
undergo the said
procedures.
* To make sure that

* Abdominal Perineal Preparation perineal area is clean DONE
and as a pre op
preparation for CS.
* Inform OR and the

* Inform OR (PROD/AROD) anesthesiologist for the DONE
patient’s schedule of
operation.
DONE
* Cefazolin an anti-
Cefazolin 1g IVTT q 8º infective. Treats skin and
38
skin structue infection. DONE
* For co-management
* Refer
* To restore/increase DONE
* To secure 1 unit of PRBC of patient’s circulating blood volume
blood type for on use. after childbirth.
8-30-08 POST OP ORDERS

9:35 am
DONE
* To PACU then to OB ward * For close monitoring of
the recovery.
DONE
* NPO * The client is not
allowed to take any food
until she can flatus. This
is a sign that the
gastrointestinal system is
starting to function.
DONE
* VSq15 until stable then q hourly

* Monitor closely of the
patient’s condition
DONE
* This intravenous fluid
* IVF with D5LR 1L+10units oxytocin @ helps in supplying
120cc/hr potassium and calcium to
provide adequate fluids
and electrolytes for
maintenance of body
function. It also has
oxytocin to control
bleeding.
* Meds:
39
* Tramadol for
- Tramadol 50 mg q 6 hours slow IVTT management of pain.
DONE
* Ketorolac is an
- Ketorolac 30 mg q 8 hours IVTT analgesic, and it is a
short-term management
DONE
- Ranitidine 50 mg q 8 hours IVTT of pain.
* Ranitidine decreases
gastric acid secretion. DONE
*For treatment
* continue meds
DONE
* Oxygen therapy may be
* O2 inhalation @ 4-6 L/min needed to treat DONE
abnormally low blood

oxygen.
* To provide a good
DONE
* Keep patient warm environment for
recovery.
*Measurement of a
* I & O monitoring q hourly then q shift patient's fluid intake and DONE
output will identify those
patients at risk of
becoming dehydrated or
over hydrated.
* For closely monitoring

* Watch out for unusualites the patient’s condition. DONE
*for co-management
08-31-08
* Refer DONE
5:00 am
*To replace blood loss.
DONE
* For BT to start @ PACU
* It is ordered for easy
40
* General liquids and crackers, soft diet tolerance and digestion
once with flatus as client’s peristaltic
DONE
movement is still slow.

* VSq4 patient’s condition
DONE
* Consume and
* C/D IVF and IVTT meds discontinue IVF and IVTT
medication to shift and DONE
continue medication
orally.
* Meds: * Cefadroxil is the

- Cefadroxil 50 g 1 cup BID treatment for skin and
skin structure infection. DONE
- FesO4 1 cup OD * Ferrous sulfate is used

to treat iron deficiency
- M. Maleate 1 tab TID anemia (a lack of red
DONE
blood cells caused by
- Diclofenac K+ 50 g 1 tab TID having too little iron in
the body).
* M. Maleate directly
stimulates unterine and
vascular smooth muscle. DONE
* Diclofenac is a
nonopoid analgesics,
that suppress pain and
DONE
inflammation.
* To assess patient for

* Remove foley catheter, should void 4-6º urinary function.
DONE
* Enhances circulation
* May sit up on bed
41
and return of normal DONE
organ function
* Refer *For co-management
DONE
* Soft diet as ordered for
09-01-08
* Soft diet, DAT once with BM easy tolerance and
9:00 am DONE
digestion as client’s
peristaltic movement is
still slow.

* VSq4º
patient’s condition
DONE
* This is to prevent
* For wound dressing infection.
DONE
*This is for treatment and

* Continue PO meds continuity of care
DONE
09-02-08 * The client May Go
* MGH
Home, she is ready to
DONE
stay at home but should
recommend continuing
the compliance of her
medications.
* Cefadroxil is the
* Take home meds:
treatment for skin and
DONE
skin structure infection.
- Cefadroxil 500mg 1cp BID
* Ferrous sulfate is used
to treat iron deficiency DONE
- FeO4 1g OD
anemia (a lack of red
blood cells caused by
having too little iron in
42
the body).
* Diclofenac is a
nonopoid analgesics,
DONE
- Diclofenac 5g 1 tab TID that suppress pain and
inflammation.
* Follow-up @ OPD on September 10, * To monitor client’s

2008 progress and response DONE
to the treatment and to
check if there are any
deviations in her health.
43
DIAGNOSTIC AND LABORATORY EXAMS
A. URINALYSIS
Actual Normal Nursing

Date Test Values Values Implications Rationale Responsibilities
07-01-08 PHYSICAL - To examine 1. Tell the patient
EXAMINATION the patient’s that the test is for
Color Straw Clear straw to Liver problems urine for sign the detection or
colored liquid or jaundice migh of renal or renal and urinary
have occur urinary tract tract disorders
disease. and assessment
of body function.
- To help
Appearance Clear Clear to slightly normal discover 2. Notify the
hazy diseases patient that the
that is not in procedure
relation with requires a urine
Reaction 6.5 4.6-8 renal sample. Urine
To demonstrate disorders. must be acquired
Specific Gravity 1.010 1.005-1.025 the most likely on the
44
concentrating first void in the
and diluting - To identify morning.
In normal ability of the drugs or
condition there kidneys. substances 3. Notify the
is no protein that has laboratory and
that can be been taken. physician of any
detect drugs that the
patient has taken
CHEMICAL that may affect
EXAMINATION the results.
Albumin Negative Normal
Sugar Negative Presence of

sugar in urine
may indicate
diabetes,
chronic kidney
disease
45
MICROSCOPIC
EXAMINATION
Epithelial Cells Pus cells and May be a sign of
Squamous 0.2 hpf bacteria should swelling in the
Renal be absent in kidney and
Pus Cells urine pelvic region,
urethral
ulceration and
chronic specific
inflammatory of
the bladder
RBC Blood in the

urine may
sometimes a
serious urinary
tract problem
Mucous Threads
Bacteria #
46
Yeast Cells
Oil Globules
Spermatozoa
B. BLOOD TYPING
47
Nursing
Date Test Result Normal Results Implications Rationale Responsibilities
8-18-08 Blood Type A (+) In forward typing, if None known - To check 1. Inform the
(ABO+Rh) there’s agglutination compatibility patient that the
patient’s RBC’s are of the donor test determines
mixed with anti-A and and the her blood group.
anti-B serum, the A patient before
and B antigen is transfusion. 2. Notify the
present, thus blood patient that the
type is O test blood
sample thus
venipuncture is
done.
3. Check the
patient’s history
for recent
administration of
blood, dextran or
I.V.
48
4. After the
procedure apply
direct pressure
to the
venipuncture to
the site until
bleeding stops.
C. COMPLETE BLOOD COUNT
Normal Nursing
49
Date Test Result Values Implications Rationale Responsibilities
8-18-08 WBC H 15.19 5-10 Leukemia, - To verify 1. Explain to the
x10^3/uL x10^3/uL bacterial infection or patient the necessity
infection, severe inflammation in of undergoing the
sepsis the body and test that it helps
observe its detect occurrence of
responses to anemia and
specific polycythemia.
therapies.
2. Notify the patient
that the test requires
Hemoglobin 122g/L 115-155 Normal - To recognize blood sample as well
g/L Low HCT, the amount of as the person who
suggest anemia, O2 carrying will perform the
hemodilution or protein venipuncture and the
enormous blood contained within time.
loss. the RBC
3. Inform the patient
that the procedure is
Hematocrit L 0.35 0.36-0.48 Rule out anemia - To identify the of slight discomfort
due to percentage of and may feel a little
50
nutritional the blood pain.
deficiencies, volume
blood loss. occupied by red 4. After the
blood cells. procedure, apply
direct pressure to the
venipuncture until
RBC L 4.02 4.20-6.10 Low RBC is due - To know the bleeding stops.
x10^6/uL x10^6/ uL to enormous amount of RBC
blood loss which in the blood. 5. Refer if
results to venipuncture
anemia. develops hematoma
Leukemia, and monitor the
hemorrhage. pulses distal to the
site.
Differential
Count
Neutrophil 73% 55-75% Normal - To point out

the presence of
51
bacterial
infection and
amount of
Leukocyte
Lymphocytes L 18% 20-35% Leukemia, -To recognize if

systemic lupus there is an
erythematosus unusual amount
of lymphocyte
that may
indicate viral
infection such
as HIV.
Monocytes 7% 2-10% Normal -Increase of

these may
respond to
corticosteroid,
with pus
conditions,
52
hemorrhage
Eosinophil 2% 1-6% Normal -High

percentage of
eosinophil, may
indicate
bacterial
infestation or
allergies
Basophil 0% 0-1% Normal -Increase of

basophil may
indicate
parasite,
hypersensitiven
ess and
heartworm
causing
endocrine
disease, chronic
liver disease
53
MCV 88.1fl 79.40- Normal -To determine
94.80 fl the ratio of
hematocrit to
RBC count
-To identify the

MCH 30.3 25.60- Normal average mass
pg 32.20 pg of hemoglobin
per RBC
MCHC 34.5 g/dL 32.20- Normal -Indicates the

35.30 g/dL nature and
volume of
hemoglobin, to
high may
indicate
spherocytosis or
in vitro
54
hemolysis
D. ULTRASOUND
Nursing
Date Test Result Impression Rationale Responsibilities
06-21-08 U -Presentation : Cephalic Single, live - To know fetal 1. Assure a
2:35 pm L -Number: single intrauterine and consent form
T - Amniotic fluid: AFI 11.1 cm pregnancy, pregnancy signed by the
R -Placental location: anterior cephalic abnormalities patient. Explain
55
A -Placental grade: III presentation, with and that the procedure
S -Sex: male good cardiac and measurement is painless and
O -AOG: 32W 3D somatic activities; of organ size safe and that no
U -EDD: 10-11-08 BPD= 32 weeks and structure. radiation
N -FHB: 147bpm and 5 days; FL= To identify and exposure is
D Estimated Fetal Weight: 2233 g 31 weeks and 1 differentiate involved.
-normohydramnios (11.1 cm) day cyst and solid
-amniotic fluid volume: normal Placenta anterior, tumor. 2. Emphasize the
-previa: placenta previa totalis early grade III, importance of
totally covering - To ensure remaining still
Biophysical profile: the OS (Placenta the during the scan to
-amniotic fluid: 2 previa totalis) presentation prevent distorted
-fetal tone: 2 and identify image.
-fetal breathing: 2 complications
-gross movement: 2 of the fetus. 3. Assist the
Total =8 To detect if patient into a
there is risk of supine position; if
pregnancy. possible use
pillows to support
the area to be
examined. Coat
56
the target area
with a water-
soluble jelly. If
necessary to
assist the patient
into lateral
positions for
consequent view.
57
NURSING THEORIES
Nightingale’s Environmental Model
Nightingale Environmental areas that a nurse can control are: ventilation

and warming, light, noise, variety, bed and bedding, personal cleanliness,
nutrition and taking food, and chattering hopes and advices. When one or more
aspects of the environment are out of balance, the client will be using increased
energy to counter the environmental stress. The stresses drain the client of
energy that should’ve been used for healing. It is the role of the nurse to
manipulate the environment to compensate for the client’s response to it.
Our patient was admitted to the OB ward of DMC hospital after her CS
delivery. The environment was not well ventilated and body odor from the great
number of people confined to the same area contributed to the unpleasant smell
in the whole of the ward. The place was also very warm. Nurses should then
advise patients to dress lightly and avoid wrapping newborns heavily to prevent
hyperthermia. Most of the beds were soiled, untucked, or didn’t have any bed
sheet at all. Not all wall fans are also functioning well and so it leads to a warmer
environment. As a nurse we should give health teachings as our main role
concerning personal hygiene so as to promote better health. For our client, we
told her to take a bath, change clothing everyday, and to do simple exercises so
that she won’t experience any bed sores or fatigue.
58
Lydia Hall’s Care, Core, Cure theory
Lydia Hall’s theory is visually presented by interlocking circles and each

represents a particular aspect of nursing. The three circles represent the care,
core and cure. The major aspect of care is to achieve an interpersonal
relationship with the health care provider that will much more facilitate
development. This aspect provides motherly care and comfort, provide teaching-
learning activities and support the daily biological function of the patient. The
closeness of the nurse and patient promotes the sharing and exploration of
feelings with the nurse. The core aspect emphasized the therapeutic use of self
and usage of reflective technique. The patient become more aware of the feeling
being experienced as evidenced of making conscious decision, understand and
accept feeling. The cure circle is based on pathological and therapeutic
sciences. The patient has a negative perspective about the nurse as potential
cause of pain rather than a comforting being. These three aspects function
independently but they are interrelated and the circle’s size represents the
progress in each aspect.
In our case, the care aspect shows the relationship between the patient
and the health care provider by this the patient is able to get health teaching and
support. Our patient followed our health teaching so as to avoid anymore
complications, we also told her to verbalize any feelings she would like to
express so that we could know if she needs more care to be provided so as to
promote further wellness. The core aspect helped the patient reflect on her
situation and she was able to make decision by her own. Our patient was able to
ambulate for a faster healing of wounds and she doesn’t refuse in taking her
medication daily. So from that situation we can say that she understands her
situation and so she copes up with it to promote better healing. As for the cure
aspect, when the doctor ordered that she is NPO, she followed it and the nurse
that was assigned to her also implemented it so that she won’t forget it. In that
way safety was maintained.
59
Dorothea Orem’s self-care deficit theory
Orem developed the Self-Care Deficit Theory of Nursing which is

composed of three interrelated theories: self-care theory, self-care deficit theory
and theory of nursing systems. Self-care is the performance or practice of
activities that individuals initiate and perform on their own behalf to maintain life,
health, and well-being. Self-care agency is the human’s ability or power to
engage in self-care. Therapeutic self-care demand is the totality of “self-care
actions to be performed for some duration in order to meet known self-care
requisites by using valid methods and related sets of operations and actions.
Then there are three categories of self-care requisites: universal, developmental,
and health deviation. Self-care requisites are actions directed toward the
provision of self-care. In the second vital part of Orem’s theory is the self-care
deficit theory wherein nursing is needed when the self-care demands are greater
than the self-care abilities. The nursing system is based on the self-care needs
and abilities of the patient to perform self-care activities. Orem has identified
three classifications of nursing systems to meet the self-care requisites of the
patient and these are: wholly compensatory system, the partly compensatory
system, and the supportive educative system.
We applied this theory because for a few days after the labor the patient
was not able to do self-care and shows inadequacies of self-care requisites. Also
acute pain is one of the major complaints in the post cesarean section women.
They may not want to cleanse or bath because of fear of pain, but as a nurse we
encouraged our client to perform daily hygiene and assisted her in task that she
cannot do by herself alone.
60
DRUG STUDY
Generic Name: CEFADROXIL
Brand Name: Drolex
Side Effects/
Suggested Mode of Contra Drug Adverse Nursing
Classifications Dose Actions Indications indications Interactions Reactions Responsibilities
- Ordered at 8/31/08 Cefadroxil binds to Infections -Hypersensitivity to Prothrombin time -Nausea, 1. Advise patient that
Cephalosporins - 50 g 1 cup BID one or more of the caused by cephalosporins. prolonged; bleeding vomiting, Cefadroxil may be taken with
PO penicillin-binding susceptible -Impaired renal may occur when diarrhoea, or without food (May be taken
Ordered at 9/2/08 proteins (PBPs) strains of function taken with abdominal w/ meals to reduce GI
- 500 mg 1 cup
which inhibits the organisms in anticoagulants. discomfort; skin discomfort.).
BID
final UTI, skin & Decreased rash, 2. Tell patient to take
transpeptidation skin structure elimination with angioedema; Cefadroxil exactly as directed
step of infections, probenecid. elevated liver by the doctor. Do not take
peptidoglycan pharyngitis enzyme values; more or less than instructed by
synthesis in &/or superinfection the doctor.
bacterial cell wall, tonsillitis. with resistant 3. Advise patient to alert the
thus inhibiting organisms doctor if she or he have a
biosynthesis and especially history of allergic reactions
arresting cell wall candida. (rash, breathlessness, swollen
assembly resulting -Anaphylactic mouth or eyes).
in bacterial cell reaction; 4. Tell patient to not take
death. Cefadroxil is pseudomembran Cefadroxil together with
not active against ous colitis. antacids because antacids
Proteus, could reduce the effectiveness
61
Pseudomonas, of the antibiotic.
Enterobacter, 5. Advise patient that if
Morganella, Cefradroxil have been given
Serratia and tablets or capsules, swallow it
Listeria whole.
monocytogenes.
62
Generic Name: CEFAZOLIN
Brand Name: Anzif
Side Effects/
-Anti-infective, Ordered at 8/30/08 -binds to bacterial - treatment of -hypersensitive to -increased risk of CNS: headache, 1.Assess patient for infection;
first-generation -1g IVTT q 8º cell wall skin and cephalosporins and nephrotoxicity when dizziness, appearance of wound at
cephalosporin membrane, causing structure penicillins aminoglycosides or lethargy, beginning and throughout
cell death infections collistimethate paresthesias course of therapy
-active against may -otitis media -probencid decreases GI: 2.Before initiating therapy
gram-positive cocci -urinary tract excretion and pseudomembran obtain a history to determine
infections increases blood levels ous colitis, liver previous use of and reactions
-septicemia toxicity to penicillins or
GU: cephalosporins
Nephrotoxicity 3. Obtain specimens for
Hematologic: culture and sensitivity before
Bone marrow initiating therapy.
depression 4.Do not use solutions that are
Hypersensitivity: cloudy or contain a precipitate
ranging from 5. If aminoglycosides are
rash to fever to administered concurrently, if
anaphylaxis possible, at least 1 hour apart.
Other: 6. Advise patient to report
superinfections, signs of superinfection.
pain, abscess.
63
Generic Name: Diclofenac
Brand Name: Cataflam { Voltaren Rapide)
Side Effects/
-Therapeutic: Ordered at 8/31/08 - Inhibits - PO: -Hypersensitivity DRUG-DRUG - CV: 1. Advise to administer after
nonopiod analgesics, - 50 g 1 tab TID PO prostaglandin Managemen to diclofenac or - concurrent use with hypertension meals, with food, or with an
nonsteroidal anti- Ordered at 9/2/08 synthesis. t of other aspirin may decrease -CNS: dizziness, antacid containing aluminum
- 5g 1 tab TID PO
inflammatory Therapeutic inflammator components of effectiveness drowsiness, or magnesium to minimize
agents. effects: y disorders formulation - additive adverse GI tremors gastric irritation.
suppression of including: - Cross- effects with aspirin, GI: GI Bleeding, 2. Administer as soon as
pain and Rheumatoid sensitivity may other NSAIDs, abdominal pain, possible after the onset of
inflammation. arthritis, occur with other potassium dyspepsia, menses. Prophylactic
Osteoarthriti NSAIDs supplements, heartburn, treatment has not been shown
s, including aspirin corticosteroids or diarrhea, to be effective.
Ankylosing - Active GI alcohol hepatotoxicity 3. Instruct patient to take
pspondylitis, bleeding/ulcer - chronic use with - GU: acute renal diclofenac with a full glass of
Relief of disease. acetaminophen may failure, dyuria, water and to maintain in a
milt to increase the risk of frequency, upright position for 15-30 min
moderate adverse renal hematuria, after administration.
pain of reactions nephritis, 4. Instruct patient to notify
dysmenorrh - may decrease the proteinuria health care professional of
eal. effectiveness of - Derm: eczema, medication regimen before
- Topical: diuretics or photosensitivity, treatment or surgery.
Treatment of hypertensive rashes 5. Caution patient to wear
64
actinic - may increase serum - F and E: edema sunscreen and protective
keratoses. lithium levels and - Hemat: clothing to prevent
increase the risk of prolonged photosensitivity reactions.
toxicity. bleeding time 6. Advise patient to consult
- increased risk if - Local: Tropical health care professional if
bleeding with only – contact rash, itching, visual
cefamandole, cefoten dermitis, dry disturbances, tinnitus, weigh
cefoperazone, skin, exfoliation, gain, edema, black stools,
valproic acid, rash persistent headache, or
plicamycin, - Misc: allergic influenza-like syndrome
thrombolytic agents reactions occurs.
or anticoagulants including
- may increase the Anaphylaxis
risk of nephrotoxicity
from cyclosporine.
DRUG-NATURAL
PRODUCTS
- increased bleeding
risk with anise,
arnica, chamomile,
garlic, ginger, ginko,
Panax ginseng
65
Generic Name: Ferros Sulfate, FeO4
Brand Name: Feosol, Feratab, Fer-gen-sol, Fer-In-Sol
Side Effects/
- Therapeutic: Ordered at 8/31/08 - An essential - PO: -Primary DRUG-DRUG - CNS: IM, IV – 1. Encourage patient to
antianemics - 1 cup OD PO mineral found Prevention/ hemochromatosis - Tetracycline and seizure, comply with medication
- Pharmacologic: Ordered at 9/2/08 in hemoglobin, treatment of - Hemolytic antacids ↑ oral dizziness, regimen.
iron supplements - 1g OD PO myoglobin, iron- anemia’s and other absorption of iron headache, 2. If you missed a dose, take it
and many deficiency anemia’s not due by forming syncope as soon as remembered within
enzymes. anemia to iron deficiency insoluble - CV: IM, IV – 12 hr; otherwise, return to
- Parenteral - IM, IV: - Some products compounds hypotension, regular dosing schedule.
iron enters the Iron dextran contain alcohol, - Oral iron tachycardia 3. Do not overdose or
bloodstream – tartrazine, or supplements ↓ GI: nausea; PO underdose when taking in the
and organs of treatment/pr sulfites and should absorption of – constipation, medication.
the evention of be avoided in Tetracyclines, dark stools, 4. Advise patient that stools
reticuloendoth iron- patients with fluroquinolones, and diarrhea, may become dark green or
elial system, deficiency known intolerance penicillamine epigastric pain, black and that this change is
where iron is anemia in or hypersensitivity - ↓ absorption of GI bleeding harmless.
separated out patients who - Concurrent oral and may ↓ effects of Derm: IM, IV – 5. Instruct patient to follow a
and becomes cannot iron therapy levodopa and flushing, diet high in iron.
part of iron tolerate oral methyldopa urticaria 6. Place medication out of
stores. iron - May ↓ efficacy of Local: pain at IM reach of children
- Therapeutic levothyroxine site (iron 7. Place medication at room
effects: dextran), temperature.
66
Prevention.trea DRUG-FOOD: phlebitis at IV
tment of iron - Iron absorption is site, skin staining
deficiency. ↓ 33-50% by at IM site (iron
concurrent dextran)
administration of MS: IM, IV –
food. arhralgia,
myalgia
- Misc: PO –
staining of teeth
(liquid
preparations);
IM, IV- allergic
reactions
including
anapyhylaxis,
fever,
lymphadenopath
y.
67
Generic Name: KETOROLAC
Brand Name: Acular, Toradol
Side Effects/
- Non-steroidal anti- Ordered at 8/30/08 - Inhibits Short-term Hypersensitivity; DRUG-DRUG - CV: 1. Obtain patient’s vital signs
inflammatory agents - 30 mg q 8 hours IVTT prostaglandin management cross-sensitivity - concurrent use with hypertension, to note for signs of
- Non-opioid synthesis by of pain (not with other aspirin may decrease flushing, hypertension.
Analgesics decreasing an to exceed 5 NSAIDs may effectiveness syncope, pallor, 2. Assess for patient’s
- Analgesic, anti- enzyme days total exist; labor, - additive adverse GI edema, hypersensitivity reactions
inflammatory, needed for for all routes delivery or effects with aspirin, vasodilation especially those who have
antipyretic effects biosynthesis combined) lactation; pre- or other NSAIDs, - CNS: asthma, aspirin-induced
perioperative potassium dizziness, allergy, and nasal polyps.
use; known supplements, drowsiness, 3. For patient’s experiencing
alcohol corticosteroids or tremors pain, note the type, location
intolerance alcohol - EENT: and intensity of pain prior to
- chronic use with tinnitus, blurred 1-2 hr following
acetaminophen may vision. Hearing administration.
increase the risk of loss 4. Instruct patient to make
adverse renal - GI: nausea, medication exactly as directed.
reactions anorexia, If dose is missed, it should be
- may decrease the vomiting, taken as soon as remembered
effectiveness of diarrhea, if not almost time for next
diuretics or constipation, dose.
hypertensive flatulence, 5. Advice patient to call for
68
- may increase serum cramps assistance when ambulating
lithium levels and - GU: and to avoid driving or ithe
increase the risk of Nephrotoxicity: activitiues requiring alertness
toxicity. dysuria, until response to the
- increased risk if hematuria, medication is known.
bleeding with oliguria,
cefamandole, cefoten azotemia
cefoperazone, - HEMA: blood
valproic acid, dyscrasias,
plicamycin, prolonged
thrombolytic agents bleeding
or anticoagulants - INTEG:
- may increase the pupura, rash,
risk of nephrotoxicity pruritus,
from cyclosporine. sweating
DRUG-NATURAL
PRODUCTS
- increased bleeding
risk with anise,
arnica, chamomile,
garlic, ginger, ginko,
Panax ginseng
Generic Name: Methylergonovine
Brand Name: Methergine
69
Side Effects/
- Therapeutic: Ordered at 8/31/08 - Directly - Prevention Hypersensitivity. DRUG-DRUG CNS: dizziness, 1. Monitor BP, HR, and
oxytoxic - 1 tab TID PO stimulates and Should not be - Excessive headache uterine response frequently
- Pharmacologic: uterine and treatment of used to induce vasoconstriction may EENT: tinnitus during medication
ergot alkaloids vascular post partum labor. result when used with Resp: dyspnea administration
smooth muscle. or post heavy cigarette CV: hypotension 2. Assess for signs of
- Therapeutic abortion smoking (nicotine) or GI: nausea, ergotism
effect: uterine hemorrhage other vasopressors vomiting 3. Instruct patient to
contraction. caused by such as dopamine. GU: cramps take
uterine Derm: medication as directed, do not
atony or diaphoresis skip or double up on missed
subinbolutio Misc: allergic doses
in. reactions 4. Advise patient that
medication may cause
menstrual-like cramps
5. Instruct patient to
notify
health care professional if
infection develops.
Generic Name: Oxytocin

Brand Name: Pitocin
70
Side Effects/
- Oxitoxicity Ordered at 8/30/08 - Hormone that
- To induce or - Contraindicated in Drug-drug: CNS: 1. Drug isn’t recommended for
- 10 units oxytocin causes potent
stimulate labor patients Cyclopropane subarachnoid routine I.M. use, but 10 units
IVTT
and selective
hypersensititve to anesthetics: May hemorrage, may be given I.M. after
- To reduce
stimulation of
drug cause less seizures, coma delivery of placenta to control
postpartum
uterine and
pronounced postpartum uterine bleeding.
bleeding after - Contraindicated CV:
mammary
bradycardia and
expulsion of when vaginal hypertension; 2. Never give oxytocin
gland smooth
hypotension. Use
placenta delivery isn’t increased heart simultaneopusly by more than
muscle.
together cautiously.
advised, when rate. Systemic one route.
- Incomplete or
cephalopelvic Thiopental venous return,
inevitable 3. Drug is used to induce or
disproportion is anesthetics: May and cardiac
abortion reinforce labor only when
present, or when delay induction. Use output;
pelvis is known to be adequate,
delivery requires together cautiously. arrythmias.
when vaginal delivery is
conversion, as in Vasoconstrictors:
GI: nausea, indicated, when fetal maturity is
transverse lie. May cause severe
vomitting assured, and when fetal position
hypertension if
- Contraindicated in is favorable. Use drug only in
GU: titanic
oxytocin is given
fetal distress when hospital where critical care
uterine
within 3 to 4 hours of
delivery isn’t facilities and prescriber are
contraction,
vasoconstrictor in
imminet, I immediately available.
abruption
patient receiving
prematurity, in other
placentae, 4. Monitor fluid intake and
caudal block
obstetric
impaired uterine output. Antidiuretic effect may
anesthetic. Avoid
emergencies, and in
blood flow, lead to fluid overload, seizures,
using together.
71
patients with severe pelvic and coma from water
toxemia or hematoma, intoxication.
hypertonic uterine increased uterine
5. Monitor and record uterine
patterns. motility, uterine
contractions, heart rate, blood
rupture,
pressure, intrauterine pressure,
postpartum
fetal heart rate, and character of
hemorrhage.
blood loss every 15 minutes.
Hematologic:
6. Have 20% magnesium sulfate
afibrinogenemia
solution available to relax the
possibly related
myometrium.
to postpartum
7. If contractions occur less
bleeding.
than 2 minutes apart, exceed 50
Other:
mm, or last 90 seconds or
hypersensitivity
longer, stop infusion, turn
reaction,
patient on her side, and notify
anaphylaxis,
physician.
death from
8. Drug doesn’t cause fetal
oxytocin-induced
abnormalities when used as
water
indicated.
intoxication.
Generic Name: Ranitidine hydrochloride

Brand Name: Zantac
72
Side Effects/
- Antiulcer Ordered at 8/30/08 -Competitively
- Duodenal and - Contraindicated in Drug-drug. CNS: vertigo, 1. Assess patient for abdominal
-50 mg q 8 hours inhibits action
gastric ulcer patients Antacids: May malaise, pain. Note presence of blood in
IVTT of histamine
(short-term hypersensitive to interfere with headache emesis, stool, or gastric
on the h2 at
treatment); drug and those with ranitiding absorption. aspirate.
EENT: blurred
receptor sites
pathologic acute porphyria. Stagger doses, if
vision 2. Ranitidine may be added to
of parietal
hypersecretory possible.
total parenteral nutritional
cells, Hepatic:
conditions, such
Diazepam: May solution.
decreasing jaundice
as Zollinger-
decrease absorption
gastric acid 3. Ranitidine may be added to
Ellison
of diazepam. Monitor
secretion. total parenteral nutrition
syndrome Other: burning
patient closely.
solutions.
and itching at
- Maintenance
Glipizide: May Alert: Don’t confuse ranitidine
injection site,
therpy for
increase with rimantadine: don’t
anaphylaxis,
duodenal or
hypoglycaemic confuse Zantac with Xanac or
angioedema
gastric ulcer.
effect. Adjust Zyrtec.
- glipizide dosage, as
Gastroesophage directed.
al reflux disease
Procainamide: May
- Erosive decrease renal
esopaghitis clearance of
procainamide.
- Heartburn
Monitor patient
73
closely for toxicity.
Warfarin: May
interfere with
warfarin clearance.
Monitor patient
closely.
74
Generic Name: TRAMADOL HYDROCHLORIDE
Brand Name: Tramal, Siverol
Side Effects/
- Central Nervous Ordered at 8/30/08 - Effective - Management - Hypersensitivity - Carbamazipine: - CNS: 1. Assess for level of pain
System Agent -50 mg q 6 hours agent for of moderate to to tramadol or significantly drowsiness, relief and administer PRN
- Opiate Agonist IVTT control of moderately other opioid decreases tramadol dizziness, dose as needed but not to
- Narcotic Analgeic moderate to severe pain. analgesics; patient levels (may need up vertigo, fatigue, exceed the total daily dose.
moderately on MAO to twice usual doses). headache, 2. Monitor vital signs and
severe pain inhibitors; patient Tramadol may somnolence, assess for orthostatic
acutely intoxicated increase adverse restlessness, hypotension or signs of CNS
with alcohol, effects of MAO euphoria, depression.
hypnotics, centrally inhibitors. Tricyclic confusion, 3. Discontinue drug and notify
acting analgesics, antidepressants. anxiety, physician if S&S of
opioids, or Cyclobenzaprine, coordination hypersensitivity occur.
psychotropic drugs; phenothiazine, disturbance, 4. Assess bowel and bladder
patients on selective serotonin- sleep function; report urinary
obstetric reuptake inhibitors, disturbances, frequency or retention.
preoperative MAO inhibitors may seizure. 5. Use seizure precautions for
medication; enhance seizures risk - CV: patients who have a history of
lactation. with tramadol, may palpitations, seizures or who are
Debilitated increase CNS adverse vasodilation concurrently using drugs that
patients; chronic effects when used - GI: nausea, lower the seizure threshold.
respiratory with other CNS constipation, 6. Monitor ambulation and
75
disorders; liver depressants. Herbal: vomiting, take up appropriate safety
disease; renal St. John’s wort may xerostomia, precautions.
impairment; increase sedation. dyspepsia, 7. Exercise caution with
myxedema; diarrhea, potentially hazardous activities
hypothyroidism; or abdominal pain, until response to drug is
hypoadrenalism; anorexia, known.
acute abdominal flatulence 8. Understand potential
conditions; - Body as a adverse effects and report
increase ICP or whole: sweating, problems with bowel and
head injury; history anaphylactic bladder function. CNS
of seizures; reaction (even impairment, and any other
pregnancy with first dose) bothersome adverse effects to
(category C); - SPECIAL physician.
patients >75 yrs. SENSE: visual 9. Do not breastfeed while
safety and efficacy disturbances taking this drug.
in children are not -
established. UROGENITAL:
urinary retention/
frequency,
menopausal
symptoms
NURSING CARE PLAN
76
Date/ Nursing Objectives of
Time Cues Need Diagnosis Care Nursing Intervention Evaluation
S Subjective : C Acute pain related Within the 4 1. Monitor and record vital signs September
E “naa gihapon O to presence of hours span of Rationale: Monitoring the patient helps in the 03,
P gamay na G surgical incision care, patient will continuity of care. Vital signs are also important to 2008
T sakit tungod N secondary to be able to report determine the difference between the normal and the @
E sa akong I cesarean section reduced pain as not. 4:00 am
M tahi” T evidenced by 2. Assess for appropriate referred pain.
B I Rationale: client’s Rationale: Assessment helps determine possibility of
E Objective: V verbalization. underlying organ dysfunction requiring treatment. Goal met
R E acute pain is an
- Guarding - unpleasant sensory 3. Acknowledge the pain experienced and express
2, behavior P and emotional acceptance of client’s response to pain. After the 4
E experience arising Rationale: Pain is a subjective experience and hours span of
2 - pain scale of R from actual or cannot be felt by others. care, patient
0 2 out of 5 C potential tissue was able to
0 E damage or 4. Provide comfort measures such as back rub and report
8 - grimaced P described in terms f changing of position reduced pain
face T such damage Rationale: to provide nonpharmacological care and
U (international management. verbalized,
A Association for the “hay salamat
@ L Study of Pain); 5. Teach patient relaxation techniques like deep- nakaginhawa
sudden or slow breathing exercise pud ko maski
12am P onset of any Rationale: to alleviate pain gamay.”
A intensity from mild
T to severe with an 96. Promote sufficient resting periods particularly
T anticipated or when apply too much effort to an activity
E predictable end and Rationale: Adequate rest period prevent fatigue.
77
R a duration of less
N than 6 months 6. Evaluate measures done and inform client when
management may cause pain.
Rationale: the client’s knowledge regarding episode
78
Date/ Nursing Objectives of
Time Cues Need Diagnosis Care Nursing Intervention Evaluation
S Subjective : A Activity Intolerance At the end of our 1. Establish rapport September

E “Dili pa kayo C related to shift, patient will R: Patient will gain trust and cooperation. 03,
P ko T generalized use identified 2. Assist patient with activities and monitor patient’s 2008
T makatarong I weakness techniques to use of assistive devices such as chair. @
E ug lakaw” V secondary to post enhance activity R: It will protect the patient from injury. 4:00 am
M I cesarean section such as walking. 3. Promote comfort measures and provide for relief
B Objective: T of pain.
E - weakness Y Rationale: R: It enhances the ability of the patient to participate Goal met
R noted - in activities.
- moves E Activity intolerance 4. Plan care with rest periods between activities.
2, slowly X is insufficient R: Reduces fatigue At the end of
- needs E physiological or 5. Provide positive atmosphere, while acknowledging our shift, the
2 assistance to R psychological difficulty of the situation for the client. patient was
0 balance C energy to endure or R: Help minimize frustrations. able to
0 before I complete required enhance
8 standing up. S or desired daily act. activity such
E as walking.
P
@ A
T
12am T
E
R 79
N
80
Date/ Cues Need Nursing Objectives/ Nursing Intervention Evaluation
Time Diagnosis Plan with Rationale
with Rationale
S Subjective : H Risk for infection Within the 4 1. Establish rapport with the patient and
E “gi CS man ko E related to hours span of significant others.
P sa akong A presence of care, patient Rationale: Establishing rapport is essential in September 2,
T pagpaanak” L surgical incision will be able to gaining the trust and cooperation of the patient 2008
E T secondary to identify which can greatly help in meeting the goals set @
M Objective: H cesarean section. interventions for the patient 4:00am
B - to prevent/
E - Client is 3 P Rationale: reduce risk of 2. Monitor and record vital signs GOAL MET
R days E Client’s infection. Rationale: Monitoring the patient helps in the
postpartum R undergoing a continuity of care. Vital signs are also essential Within my 4
2, C surgical to determine deviations from normal hours span of
- Client E procedure impairs care, patient
2 underwent a P the body’s normal 3. Observe for localized signs of infection at was able to
0 cesarean T defense insertion sites of invasive lines, sutures, identify
0 section. I mechanisms; surgical incisions/ wounds. interventions
8 O thereby, Rationale: Assessing the client helps determine like taking a
- Surgical N increasing the prioritization of care. bath to
@ incision on the risk of being prevent/reduce
abdomen H invaded by 4. Emphasize the importance of perineal care risk of infection
12am E pathogenic and proper hygiene (e.g., wiping from front to and as
- Client lacks A organisms. back and changing soaked perineal pads evidence by
11-7 personal L (Sue C. Delaune, regularly) “maligo dyud
hygiene T Patricia K. Rationale: These reduce the risk of ascending diay dapat ko
H Ladner, urinary tract infection. para malimpyo
- Bed linens M Fundamentals of ko,” as
are dirty and A Nursing, 2006) 6. Change surgical/other wound dressings as verbalized by
not wrinkle- N indicated, using proper technique for client.
81
free A changing/disposing of contaminated materials
G Rationale: Sterile technique prevents
- Binder on E contamination and reduces risk for infection.
Date Cues Need Nursing Objectives of Nursing Interventions Evaluation
Diagnosis Care
S Subjective: A Self-Care Within the Independent:
September
E > “Wala pa ko C Deficit span of 4 1.) Assess exact cause of deficit
02,
P nakaligo sukad T related to hours of care, R: Different causes may require 2008 @
4:00 am
T nanganak ko.” I post patient will be more specific interventions to enable
E Objective: V cesarean able to safely self-care. Goal met
M  inability to I section. perform self- 2.) Situate short-term goals with
After 4 hours,
B wash body or T care activities. client.
client was able
E body parts Y R: Impaired R: To aid learning and decrease
to perform
R  untidy - ability to aggravation.
safely self-
01, appearance E carry out, 3.) Promote independence, but
care activities
2008  untrimme X bathing/ intercede when patient cannot
within level of
d nails E hygiene, perform
own ability.
12:00  physical R dressing R: To drop off disappointment.
am immobility C and 4.) Make use of consistent practices
82
noted I grooming, of daily hygiene.
 2 days S or toileting R: This facilitates the client to put in
post CS E activities order and carry out self-care skills
 Foul odor for oneself 5.) Provide recurrent support and
noted (on a assistance as needed with dressing.
temporary, R: To reduce energy outflow and
permanent, aggravation
or 6.) Encourage patient to do own self
progressing care practices.
basis) 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.
83
R: This helps client to organize and
carry out self-care skills
84
PROGNOSIS
Criteria Good Fair Poor Justification Rationale

Onset of Upon the start When the
illness of bleeding, manifestations
X immediately are being
went to see experienced
the doctor and and
has unusualities are
undergone being detected,
ultrasound. it should be
She was given time as
detected with early as
placenta possible so as
previa and not to make
informed to things
take a lot of complicated.
rest that would Through the
lessen the help of medical
bleeding. assistance and
diagnostic
examinations, it
would help a lot
in identifying
the condition..
Duration of From the start The patient’s
illness of the first initiative to
X bleeding, she obey the doctor
consulted the is one way or
doctor another a help
85
immediately. in preventing
She was further
advised to complications.
take a lot of It would also be
rest and told a factor in the
by the doctor progress of the
to consult the patient’s
doctor again if condition.
bleeding
would still
occur. By the
second time
she had her
bleeding, she
went back
immediately to
the doctor.
Environment Their place is The
X conducive for continuance of
the client’s clean
condition. environment
They live far plays a role in
from the the recovery of
polluted and the patient. The
noisy city. environment is
Their house is a factor that
clean and they affects the
see to it that it health and
is not messed illness of the
up. It is a individual.
good place
86
wherein the
patient can
take a good
rest.
Family Well The family
Support X supported by members offer
the family, encouragement
from the start to the family
of her member who is
condition, the sick. Their
husband told motivation is a
her to stop great help in
from her work the progress of
so that she the client’s
could take a condition.
lot of rest. Her
sister in laws
took over of
the household
chores.
Willingness The client The compliance
to take X takes her to the treatment
medications medications regimen is one
as ordered by of the best
the doctor but ways to have a
in some good
instances, advancement in
they cannot the condition of
afford some of the client.
the
medications
so the client
87
sometimes
cannot
complete the
period
wherein she
should take
the prescribed
medications.
Precipitating The client is these factors
Factors X pregnant that are modified
cause her to the occurrence
develop a of the illness
placenta will be
previa, a low prevented or
implantation of less
the placenta complication.
covering the
cervical os.
She is
pregnant with
her second
child and it is
a male fetus.
Predisposing Among the The
Factors X 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
88
change.
CALCULATIONS:
Good: 3 x 4 = 12
Fair: 2 x 2 = 4
Poor: 1 x 2 = 2
TOTAL: 15 = 18 / 7 = 2.57
Range of Value: 1.0 - 1.6 for Poor; 1.7 - 2.3 for Fair; 2.4 – 3.0 for Good
Client has a GOOD prognosis as shown in the computation. She has a

chance of recovering from her condition, placenta previa totalis.
HEALTH TEACHINGS
* Encourage patient to express feelings and concerns

® So that relief measure may be instituted
89
* Teach family / significant others to foster independence, and to intervene if the
patient becomes fatigued, is unable to perform task or becomes excessively
frustrated
® Demonstrates caring / concern
* Teach patient perineal hygiene

® to decrease risk of ascending infections
* Splint incision when moving or coughing

® to decrease pain and to prevent wound separation
* Encourage the patient to comply with medications given

® The use of medicines is a pharmacologic method that aids in the recovery of
the client
*Encourage the client to eat foods to stimulate the production of milk

® For the nutrition of her baby
*Teach signs of post-op complications and report the ff. signs to health care
provider:
• temperature exceeding 38C
• painful urination
• lochia heavier than normal period
• wound separation
• redness or oozing at the incision site
• severe abdominal pain
*Teach postpartum pain relief after cesarean birth

-INCISIONAL pain
• splint incision with a pillow when moving or coughing
• use relaxation techniques such as music, breathing, and dim lights
90
• apply heating pad to the abdomen
*GAS pain
walk as often as you can
• Don't drink or eat gas-forming foods, carbonated beverages, or whole milk
• Take antiflatulence medication if prescribed
• Lie on your left side to expel gas
• Emphasize to client to regularly perform wound dressing
® Prevent infection
• Inculcate to the client the importance of proper hand washing

® Hand washing if the single most effective way in controlling infection
91
DISCHARGE PLAN
Medications:
• Teach patient and her family or significant others the proper dosage and
the right time to take the medication.
• Emphasize to the patient the importance of obediently taking the
prescribed medications and the disadvantages or complications that may
arise if these are not taken properly.
• Inform and discuss the possible side effects and reactions that these
drugs might produce and seek medical attention immediately is these
arise
• Discourage to use of OTC medications or at least inform the physician if
she’s taking other OTC medications. This is essential to prevent any
occurrence of drug interactions.
Exercise:
• Tell client to refrain from straining activities

• Encourage ambulation as a form of light exercise that would help in the
progression of her recovery and wound healing.
• Range of motion. Encouraging the patient to do some exercises would
allow good blood circulation as well as the prevention of the occurrence of
bed sores.
• Encourage patient to do some stretching exercise to prevent stiffness of
the bone due to less activity performed.
• Encourage patient to first sit up and dangle feet before standing from a
lying position to prevent orthostatic hypotention
92
Treatment
• Discussing the purpose of treatments to be done and continued at home

and report to the health professional when there is bleeding to alleviate
symptoms of the patient’s condition and monitor for her recovery.
• Encourage patient to have a sufficient rest and sleep to maintain internal
equilibrium
• . Provide a safe and comfortable environment because it could make the
patient more relaxed which is also needed to arrived with a good
prognosis
Hygiene:
• Discuss the significance of personal hygiene and proper hand washing in

preventing infections
• Give client some lectures about proper wound care through changing the
dressing as often as possible so as to protect the wound from invasion of
microorganisms as well as to reduce the risk of microorganism
transmission to others.
Outpatient Care:
• A follow up check-up is necessary for wound evaluation and to assess the

progression of wound healing.
Diet:
• Encourage the patient to increased fluid intake and to include fruits and
vegetables rich in vitamin C for the production of milk needed for lactation.
• Taking food rich in protein is also helpful for tissue repair.
93
REFERENCE
 DeLaune, S.C. 2006. “Fundamentals of Nursing: Standards and Practice.”

3rd ed. New York: Delmar.
 Maternal and child health nursing. Pillitteri. Fifth edition.2007. Lippincott

Williams & Wilkins.
 Maternity Nursing. Seventh edition. Lowdermilk & Perry.
 Fundamentals of Maternal and Child Nursing Care, London, Marcia;

Ladewig, Patricia W.; Wall, Jane W.; Bindler, Ruth C.; Pearson Education,
Inc., 2007
 Nursing 2008 Drug Handbook, Lippinocott, Wilkins &Williams, 2008
 Kozier, B., Erb, G., and Oliviere, R. 2004. “Fundamentals of Nursing:

Concepts, Process, and Practice.” 7th ed. Redwood City, Ca: Addison-
Wesley
 Marriner-Tomey, S. 2002. “Nursing Theorists and Their Works.” 5 th ed. St.

Louis: Mosby.
 KUNA: A Maternal and Child with Pediatric Nursing Handbook, 1st ed.,
Aaron “CY” Tuesca Untalan, RN
 http://www.usaid.gov
 http://www.wikipedia.org
94
 http://www.emedicinehealth.com
 http://www.usaid.gov
 http://academic.kellog.edu/herbrandsonc/bio201_McKinley/f28-
2_sagittal_section_c.jpg
 http://www.webdelbebe.com/wp-content/uploads/2006/11/placenta.jpg
 http://www.answers.com/topic/placenta
95

CP Placenta Previa

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What is discussed in the introduction?

What is discussed in the introduction?

What complications during pregnancy are mentioned?

What complications during pregnancy are mentioned?

ACKNOWLEDGEMENT

Our genuine gratitude to our beloved parents for always supporting us

To our adored mentors and clinical instructors especially Mrs. Aurea

Pregnancy is an exciting time in any parent's life. It's a time of change,

is being taken for granted.

and consistent prenatal care results in improved fetal and maternal

outcomes, regardless of complications that may occur.

One of these complications, placenta previa, is a condition in which the

placenta implants in the lower part of the uterus.

Placenta previa is experienced in 1 out of 200 pregnancies around the

locality of Davao is 0% as of 2007.

During our duty in the Ob ward at Davao Medical Center , we decided to

totalis because we would like to have a deeper understanding about this

good prognosis. Management should therefore always be based on appropriate

could help in the prevention of further pregnancy complications.

Family Health History

The patient's grandfather on her mother's side, Bernardeno, died due to

History of Past Illness

History of Present Illness

Mother’s Side Father’s Side

Bernardeno Teofila Francisco Ely

Delia Evangeline Gloria Bernard Libeth Paulino Regina Teofredo

Hazel Skema Glenn Paul Barry

Legend: Ω - Placenta Previa ♫ - asthma ↑ - hypertension

Theorist Theory Developmental Task Result and Justification

She and her partner have already a

She has achieved this task. She takes

6. Getting started in an She has achieved this task. She was a

7. Taking on civic responsibility She votes during election period. She

8. Finding a congenial social √ She achieved this because she joins

personality of the person; failure commitments with someone

PLACENTA PREVIA TOTALIS

• Low Segment Transverse Cesarean Section - the incision is always made

• Low Segment Transverse Cesarean Section - Incision made horizontally

• Low Segment Transverse Cesarean Section - the incision is made

• Placenta previa - is an obstetric complication in which the placenta has

• Placenta previa is an obstetric complication that occurs in the second and

• Complete placenta previa - is where the placenta completely covers the

• Placenta Previa Totalis – is implanted in the lower segment near or over

• Total placenta previa - covers and blocks the cervical opening

We received Mrs.Skema, 23 years of age, 5’2’’ tall, weighing 55kg, 2

The head configuration is normocephalic. Facial movements are

The external pinnae are symmetrical. The gross hearing is also

Chest and Lungs

Shape of chest is normal and with symmetrical lung expansion. Thorax is

The apical pulse is auscultated at the left midclavicular line, fifth

Breast and Axillae

Client has a rounded shape breast, slightly unequal in size, however

Has soft, globular, non-distended abdomen. Horizontal (transverse) type

The vagina is a hollow musculomembranous canal located posterior to the

The ovaries are grayish-white and appear pitted or with minute

The uterus is a hollow, muscular, pear-shaped organ located in the lower

Anatomically, the uterus consists of three divisions; the body or corpus,

Organ that develops in the uterus during pregnancy. It is a unique

It is located posterior to the mons veneris spread two hairless fold of

The clitoris is a small rounded organ of erectile tissue at the forward