bleeding love manuscript

8/6/2019 Bleeding Love Manuscript

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#16 Tandang Sora Avenue, Sangandaan, Novaliches, Quezon City

S.Y. 2009 2010

CASE PRESENTATIONAbruptio Placenta

BLEEDING LOVE

Submitted by:

Oco, Jenny Rose Oreta, Charlotte Jenniffer Reyes, Jinky Rose Sy, William Franz Tumbaga, Jean Claudine

Traquena, Shayne Velasco, Racquel Vergara, Alyssa Dawn Verona, Vercely, Villa, Mario Roberto


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Case Presentation

Abruptio Placenta

TABLE OF CONTENTS

I. INTRODUCTION.. 1

A. Background of the study 1B. Significance of the study 2C. Case Explained... 2D. Objectives 3E. Nursing Theories. 4-6

II. PATIENTS DATA

A. General data 7B. Chief Complaint.. 7C. History of present illness... 8D. Past medical history 8E. Family medical history 8F. Personal and Social history.. 9G. Review of systems.. 10-11

H. Physical examination.. 12-16I. Admitting Diagnosis 16J. Course in the ward. 16-18K. Final Diagnosis 18

III. REVIEW OF RELATED LITERATURE

A. Maternal cigarette smoking as a risk factor 19for placental abruption, placenta previa,


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and uterine bleeding in pregnancy

Case Presentation

Abruptio Placenta

IV. ANATOMY AND PHYSIOLOGY

A. Anatomy and Physiology of the Placenta 20-21

V. PATHOPHYSIOLOGY

A. Pathophysiology of abruption placenta 22B. Written Explanation. 23

VI. LABORATORY PROCEDURE

A. Complete Blood Count 24-26

VII.DRUG STUDY 27

A. Ranitidine Hydrochlorid.. 28B. Ketorolac Tromethamine 29-30C. FERROUS SULFATE

.. 31

D. TRANEXAMIC ACID. 32

E. MEFENAMICACID

F. Cefazolin Sodium

G. Diphenhydramine.


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H. C0-Amoxiclav..

VIII. NURSING CARE PLAN..

A. Pain in incision.B. Anxiety..C. Fever.

IX. DISCHARGE PLAN.X. BIBLIOGRAPHY

Case Presentation

Abruptio Placenta

l. INTRODUCTION

This is a case of a teenage mother who gave birth to a premature baby (37 weeks old) that had serious

complications during pregnancy that lead to premature labor and bleeding. The patient diagnose for abruption placenta.

Abruptio Placenta is premature separation of the normally implanted placenta after the 20th week of pregnancy,

typically with severe hemorrhage .An increase risk of placenta abruption has been demonstrated in patient younger than

20 years old and those older than 35 year old.

Placenta may detach incompletely sometimes just 10 to 20 percent or completely and the cause is unknown

.Women who have high blood pressure, heart disease, diabetes or rheumatoid disease and women who use cigarette and

cocaine are more likely to develop his complication.

A. BACKGROUND OF THE STUDY


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Abruptio placenta remains a major cause of perinatal morbidity and mortality globally, though of most serious

concern in the developing world. As most known causes of abruptio placenta are either preventable or treatable, an

increased frequency of the condition remains a source of medical concern.

Normally the placenta is located in the upper part of the uterus firmly attached to the uterine wall. In abruptionplacenta, the placenta detaches from the uterine wall prematurely, causing the uterus to bleed and reducing the fetus

supply of oxygen and nutrients.

Patients with abruption placenta typically present with bleeding, uterine contractions and fetal distress .A

significance cause of third-trimester bleeding associated with both fetal and maternal morbidity and mortality, abruption

placenta must be considered whenever bleeding is encountered in the second half of pregnancy.

1Case Presentation

Abruptio Placenta

B. SIGNIFICANCE OF THE STUDY

The importance of this study is for us student to know more about abruption placenta, its causes and the

appropriate interventions should undertake to prevent this complication among pregnant women and to further enhance

the knowledge of the public, specially those pregnant mother.

We as student nurse valued more the importance of prenatal check up, In order to avoid abruption placenta and

other pregnancy complication and to lessen the fetal and maternal mortality death. Placenta is the source of life of the

baby in order to achieve the stability of the baby in the womb. Strict monitoring must be observed. It is important thatduring 20-30 weeks of AOG the mother must undergo ultrasound. Just to ensure the safety delivery of both the lives of the

mother and the baby.

C. CASE EXPLAINED


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This case study covers Abruptio Placenta which is the partial or complete separation of the placenta, normally the

placenta is located in the upper part of the uterus firmly attached to the uterine wall. In abruption placenta the placenta

detaches from the uterine wall causing the uterus to bleed and reducing the fetus supply of oxygen and nutrients,

therefore pre-natal check-up are important to the well being of the mother and the baby.

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Case Presentation

Abruptio Placent

D. OBJECTIVES

GENERAL OBJECTIVE

Understanding regarding Abruption of Placenta.

SPECIFIC OBJECTIVE

To provide proper treatment to patient who had abruption placenta.

Patient Care

Complete Bed Rest


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Knowledge

Explain thoroughly to the patient what is abruption placenta.

Communication Skills

Provide Health Teaching

Provide Therapeutic Counseling

Professionalism

Provide Nursing Care Plan 3

Case Presentation

Abruptio Placenta

E. NURSING THEORIES

Hildegard Peplau Interpersonal Relations Model

(1952)

She defined Nursing as an interpersonal process of therapeutic interactions

Between an individual who is sick or in need of health services and a nurse

Especially educated to recognize, respond to the need for help.


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Dr. Peplau emphasized the nurse-client relationship as the foundation ofnursing practice. At the time, her research

and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. She described the

nurse-patient relationship as a four-phase phenomenon. Each phase is unique and has distinguished contributions on theoutcome of the nurse-patient interaction.

We applied this theory because in order for our patient to trust us, we strongly believe we need to build a good

relationship with our patient to get accurate information and we can give the right care. Patient DORA at a young age

experienced losing her son that she needed someone to talk to. She needs an emotional support so she can face reality

that her son had passed away. By giving her therapeutic interaction it lessen her grief.

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http://en.wikipedia.org/wiki/Nursing_practicehttp://en.wikipedia.org/wiki/Nursing_practice


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Case Presentation

Abruptio Placenta

Self Care Theory

Dorothea Orem (1971)

Individuals, families, groups and communities

need to be taught self-care.

Orem defined Nursing as The act of assisting others in the provision and management

of self-care to maintain/improve human functioning at home level of effectiveness.

The theory focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-

being. It has a strong health promotion and maintenance focus.

This theory applied because nursing is human service and nurses design interventions to provide self-care action

for sustaining health.

We applied this theory in order for patient DORA to have an independent function and health teaching like: self

care, proper hygiene, negative effect of smoking & healthy lifestyle.

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Case Presentation

Abruptio Placenta

Martha Rogers

Concept of Science of Unitary Human Beings,

And Principles of Homeodynamics

Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is

concerned with the nature and direction of human development. The goal of nurses is to participate in the process

of change.

Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen

the wholeness of the Individual and redirect human and environmental patterns or organization to achieve

maximum health.

We applied this theory to increase patient awareness in her surroundings and environment. Cleaning the environment

will help to prevent spreading of communicable disease.

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Case Presentation

Abruptio Placenta

II. PATIENTS DATA

A. GENERAL DATA

Name : Patient Dora

Sex : Female

Age : 18 y/o

Height : 5 ft and 1 inch

Date of Birth : February 04, 1991Address : xxxxxxxx27

Date of Admission : 11-25-2009

Time of Admission : 6:55 P.M.

Place of admission : Dr. Jose Fabella Memorial Hospital

Attending Physician : Dr. xxxxx xxxxx

Case Number : xxx27

B. CHIEF COMPLAINT

Bloody vaginal discharge

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Case Presentation

Abruptio Placenta

C. HISTORY OF PRESENT ILLNESS

Two days prior to admission client noticed a scanty dark red vaginal spotting.

A day prior to admission, above symptoms persist with no other accompanying symptoms, client still ignore the

condition until

Few hours prior to admission, client noticed profuse vaginal bleeding this time accompanied with severe abdominal

pain. Client was brought to Fabella for consultation and was advice to go home since it was not her due date but client

refuse since bleeding is profuse, she was observed at the ER and subsequently scheduled for emergency CS and

admitted.

D. PAST MEDICAL HISTORY

Positive history of UTI

Consultation was done and prescribed with amoxicillin 500mg / capsule taken TID for 1 week.

E. FAMILY MEDICAL HISTORY

FATHER MOTHER

Hypertension ( - ) ( - )

Diabetes ( - ) ( - )

Asthma ( - ) ( +)

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Case Presentation

Abruptio Placenta

F. PERSONAL AND SOCIAL HISTORY

Patient Dora belongs to broken family; she is the youngest among the 3 siblings. Her father resides at Quezon

Province and her mother resides in Quezon City with her new husband. Her 2 elder brothers have their own families to

take care. Every summer, patient Dora goes to Quezon Province to visit her father. Patient Dora lives with her mother

together with her step-father. They live in a depressed area. During her teenage life she was looking for love and

belongingness, she found it through her peers and set of friends. She learned to smoke and occasional drinking of alcohol

at early age until during her pregnancy.

OB HISTORY

Menarche : 12 years old

Intervals : 28 days cycle

Duration : 3 to 4 days

Amount : 4 to 5 napkins

Sign & Symptoms : ( + ) Dysmenorrhea

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Case Presentation

Abruptio Placenta

G. REVIEW OF SYSTEM

REVIEW OF SYSTEM

SKIN

( -) Delayed Skin Tugor( +) Dryness(+ ) Pale

HEENT

(+ ) Headache( +) Dizziness(- ) Sore throat( +) Blurring of vision( +) Flaring of nostrils

RESPIRATORY

(+ ) tachypnea(+ ) difficulty of breathing(- ) cough(+ ) crackles

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Case Presentation


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Abruptio Placenta

CARDIAC ENDOCRINE

( -) tachycardiac( -) murmurs ( -) polydipsia (- ) polyuria

(- ) polyphagia

GASTROINTESTINAL

(- ) nausea

(+ ) abdominal pain

(- ) vomiting

GENITOURINARY

(- ) dysuria

( -) incontinence

MUSKOLOSKELETAL

( +) muscle weakness

( -) fracture

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Case Presentation

Abruptio Placenta


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H. PHYSICAL EXAM

GENERAL SURVEY

(+ ) Conscious ( +) Drowsy( -) Unconscious ( +) Lethargic

( -) Alert

VITAL SIGNS

(120/80 mmHg) BP ( 18 cpm) RR

(89 bpm ) PR (37 C) Temp

SKIN

( +) Warm ( +) Dry

(- ) Cold (- ) Moist

HEENT

Conjunctive

( -) Pink

( +) Pale

NECK(+ ) Supple( -) Tense

12Case Presentation

Abruptio Placenta


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CHEST AND LUNGS

( -) Asymmetrical

(+ ) Symmetrical

HEART

(- ) Adynamic

( -) Dynamic

ABDOMEN

(- ) Scaphold

( -) Distended

EXTREMITIES

( -) Deformities

( -) Cyanosis

RECTAL EXAM

( -) Skin Tag

(- ) Presence of Blood on lactating fingers

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Case Presentation

Abruptio Placenta

General survey


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-pt. dora is short and slim appears to be her age (18y.o)

-Awake, alert and aware of the environment

-Pt. is lethargic,

-feels drowsy and presence of guarding her incision site

Vita signs

120/80 mmHg 18 cpm

89 bpm 37 C

SKIN

-skin is hot and dry

-+ appearance of scars

- pinch up skinfold returns immediately to normal position

-absence of edema

Nail

- clean curved hard nail

Heent

-sclera smooth,white ,glossy and moist

- pale conjunctiva

14Case Presentation

Abruptio Placenta

Neck


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- symmetrical, proportional to head and shoulder

- coordinate and controlled movement

Chest and lungs

- Symmetrical- Regular rate and rhythm- Spine is straight, without lesions or masses- Normal sloping of ribs

Heart

- No lesions, masses and abnormalities

Abdomen

- unable to sit or lie comfortably and pain in moving

extremities

- No deformities

Rectal exam

- Smooth without masses, lesions and tenderness15

Case Presentation

Abruptio Placenta

Muscuskeletal system


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- Can do active ROM

I. ADMITTING DIAGNOSIS

Pregnancy uterine 37 6/7 weeks age of gestation by LMP cephalic in labor Abruptio Placenta, Non reassuring

Fetal Status-Fetal Bradycardia.

J. COURSE IN THE WARD

November 25, 2009

At 6:00 pm the patient admitted due to vaginal bleeding prior to caesarian section the doctor ordered to monitor the

vital signs and fetal heart tone of the baby. With IVF D5LR 1L x 8 and PNSS x 8. The patient is NPO then the doctor

ordered CEFAZOLIN 2mg TID with ANST 30 mins prior to preoperative and requested for CBC. The operation started at

10:45 pm ended up 11:38 pm after the operation the doctor s order to transfuse 2u FWB that properly type and

cross matched, monitor vital signs q1 for BT reaction. Then prepared for therapeutic medication. KETOROLAC 30 mg

IV with ANST as standing dose then 15mg q 8 x 2 more doses, TRAXENAMIC ACID 500mg IV q 8x 3 more dose and

RANITIDINE 50mg IV q 8 x 3 more dose with standing orders such as NALBUPHINE 3mg IV and METOCLOPRAMIDE

10mg PRN for nausea and vomiting.

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Case Presentation

Abruptio Placenta


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November 26 ,2009

At 12nn the patient received conscious, with pale skin ,dryness and muscle weakness the doctor ordered to monitor

vital signs in every one hour, tea and cracker for her diet with continuous IVF of D5LR 1L run at 30 gtts /min. on her left

metacarpal together with one unit properly matched and cross matched of PRBC on right metacarpal and aftertransfusion doctor ordered for CBC.

Medication given were CO-AMOXICLAV 500mg 1 tablet bid ,FERROUS SULFATE 1tablet bid, MEFANAMIC ACID

500mg capsule q6 .The doctor discontinued the blood transfusion due to febrile reaction of the patient and give

DIPHENHYDRAMINE 50g IV now and PARACETAMOL 500mg P.O. After 30 mins the patient was afebrile then the

blood transfusion was continued.

November 27, 2009

At 12:oo nn pt was on 3 rd BT of 1 u FWB with SN# 562909 type, BT infusing well with no BT reaction and the

doctor ordered to take soft diet and continue oral medication and monitor the vital signs. Medication were given CO-

AMOXCILAV 500MG bid FERROUS SULFATE 1 tablet bid and MEFENAMIC ACID 500MG q6 to decrease pain gradually

so that the pt can walk properly then after transfusion doctor ordered again for CBC.

November 30, 2009

At 12nn the doctor administered the patient to discharge with the medicine of CO-AMOXICLAV 625mg tab BID.

FERROUS SULFATE BID and MEFANAMIC ACID 500mg q8 hour for pain . Advised for follow up check up

17Case Presentation

Abruptio Placenta


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December 3. 2009

Still May Go Home and for follow up check up

December 4,2009

Still May Go Home

K. FINAL DIAGNOSIS

Pregnancy uterine 37 weeks, LOT delivered operatively to alive boy. Abruptio placenta non-reassuring fetal

status (FETAL BRADYCARDIA) G1P1 (1001)

18Case Presentation

Abruptio Placenta

III. REVIEW OF RELATED LITERATURE


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Maternal cigarette smoking as a risk factor for placental abruption,placenta previa, and uterine bleeding in pregnancy.

Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, USA.

The authors carried out an epidemiologic study to evaluate the role of maternal cigarette smoking as a potential risk factor

for placental abruption, placenta previa, and uterine bleeding of unknown etiology in pregnancy. Data for this prospective

cohort study were obtained from women seeking prenatal care at any of the two tertiary, seven regional, or 17 community

hospitals in the province of Nova Scotia, Canada, between January 1, 1986, and December 31, 1993. A total of 87,184

pregnancies (among 61,667 women) were registered in the database. Women who smoked during pregnancy (33%) were

compared with nonsmokers, and all women were followed until the termination of pregnancy. Placental abruption was

indicated in 9.9 per 1,000 pregnancies, while placenta previa and uterine bleeding of unknown etiology were indicated in

3.6 and 58.9 per 1,000 pregnancies, respectively. Women who smoked had a twofold increase in the risk of abruption

(relative risk = 2.05, 95% confidence interval (CI) 1.75-2.40) in comparison with nonsmokers, while the relative risk for

placenta previa was 1.36 (95% CI 1.04-1.79). However, cigarette smoking was not found to be associated with uterine

bleeding of unknown etiology (relative risk = 1.01, 95% CI 0.94-1.08). There was no evidence for an increased risk of

uteroplacental bleeding disorders with increasing numbers of cigarettes smoked. All analyses were adjusted for potentially

confounding factors through logistic regression models based on the method of generalized estimating equations. The

study confirms a positive association between cigarette smoking and placental abruption and a weak association with

placenta previa but not with other uterine bleeding. The distinct pattern of results for placental abruption, placenta previa,

and uterine bleeding of unknown origin suggests that these three uteroplacental bleeding disorders do not have a

common etiology in relation to cigarette smoking.

-Ananth CV, Savitz DA, Luther ER.

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Case Presentation

Abruptio Placenta

IV. ANATOMY AND PHYSIOLOGY


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The placenta is an organ unique to mammals that connects the developing fetus to the uterine wall. The placenta

supplies the fetus with oxygen and food, and allows fetal waste to be disposed via the maternal kidneys. The word

placenta comes from the Latin forcake, ]in reference to its round, flat appearance in humans. Protherial (egg-laying) and

metatherial (marsupial) mammals produce a choriovitelline placenta that, while connected to the uterine wall, providesnutrients 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).

STRUCTURES

Placenta averages 22 cm (9 inch) in length and 22.5 cm (0.81 inch) in thickness (greatest thickness at the centerand become thinner peripherally). It typically weighs approximately 500 grams (1 lb). It has a dark reddish-blue or maroon

color. It connects to the fetus by an umbilical cord of approximately 5560 cm (2224 inch) in length that contains two

arteries and one vein. The umbilical cord inserts into the chorionic plate (has an eccentric attachment).

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Case Presentation

Abruptio Placenta
http://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Latinhttp://en.wikipedia.org/wiki/Protheriahttp://en.wikipedia.org/wiki/Metatheriahttp://en.wikipedia.org/wiki/Umbilical_cordhttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Latinhttp://en.wikipedia.org/wiki/Protheriahttp://en.wikipedia.org/wiki/Metatheriahttp://en.wikipedia.org/wiki/Umbilical_cord


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Fever

Pain inincision

Risk forinfection in

incision

Anemia

Riskfor

infection

Bradycardia

Anxiety

V. PATHOPHYSIOLOGY

A. Diagram

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Case Presentation

Abruptio Placenta

Carbon Monoxideintroduce to the system

Excessive Smoking

Predisposing FactorAge

Lifestyle ETIOLOGY: UNKNOWN

PRECIPITATING FACTORAge: 18 y/o

5-6 packs a year

Vasoconstriction

Total separationof placenta to

the uterine

Decreased resiliency ofblood vessels at

placental bed

CSDelivery

Abruptio Placenta

FetalDistress

Abdominal

Pain

Hemorrhage intothe Decidua Basalis

Torn and rupturedBlood vessels

Abnormalcontraction of the

uterus

FHR Reassuring

DiagnosticTest

Decreased of oxygenneeded by the blood

EmergencyDelivery

Disturbed systemcirculation

POST - OP

WBC

RBCBlood

Transfusionadministration

NeonatalDeath

AllergicReaction

Vaginal Bleeding


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B.Written Explanation

23

VI. LABORATORY AND DIAGNOSTIC PROCEDURES


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COMPLETE BLOOD COUNT November 25, 2009 at 8:52 PM

TEST RESULT NORMAL VALUES UNIT SIGNIFICANCE

HEMOGLOBIN 102 120 170 g/L Note:

Decrease in values may indicate anemia.

HEMATOCRIT 0.30 0.37-0.54 % Not normal


RBC COUNT 3.48 4.1-5.1 x10^12/L Not normal.Decrease in values due to Hemmorhage.

MCV 86 80-96 fLNormal Values

MCH 29 27-31 pgNormal Values

MCHC 34 34-36 g/dL

Normal Values

WBC COUNT 14.7 4.5-11 x10^9/10 Not normal.Increase in values may indicate acute bacterial infection.

DIFFERENTIAL COUNT

NEUTROPHILS 0.80 0.00-0.55 % Not normal.

Increase in values may indicate acute bacterial infection.

LYMPHOCYTES 0.12 0.00-0.34 % Not normal.

May indicate infection if the NEUTROPHILS are elevated. (the mostcommon reason for a low lymphocytes count is an elevation in the

number of granulocytes. Granulocytes increase in many circumstances,with bacterial infections at the top of the list.)

BASOPHILS 0.00 0.00-0.01 %

MONOCYTES 0.07 0.00-0.03 %

EOSINOPHILS 0.01 0.00-0.03 %

PLATELET COUNT 253 150-400 x10^9/L


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COMPLETE BLOOD COUNT November 26, 2009 at 11:39 AM









MCHC 35 34-36 g/dLNormal Values


DIFFERENTIAL COUNT


Increase in values may indicate acute bacterial infection.


May indicate infection if the NEUTROPHILS are elevated. (the mostcommon reason for a low lymphocytes count is an elevation in thenumber of granulocytes. Granulocytes increase in many circumstances,with bacterial infections at the top of the list.)

BASOPHILS 0.00 0.00-0.01 %

MONOCYTES 0.05 0.00-0.03 %

EOSINOPHILS 0.01 0.00-0.03 %


25


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COMPLETE BLOOD COUNT November 27, 2009 at 12:15 PM









MCHC 34 34-36 g/dLNormal Values


DIFFERENTIAL COUNT


Values may increase in acute bacterial infection.


May indicate infection if the NEUTROPHILS are elevated. (the mostcommon reason for a low lymphocytes count is an elevation in thenumber of granulocytes. Granulocytes increase in many circumstances,with bacterial infections at the top of the list.)

BASOPHILS 0.00 0.00-0.01 %

MONOCYTES 0.04 0.00-0.03 %

EOSINOPHILS 0.04 0.00-0.03 %


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Case Presentation


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Abruptio Placenta

VII. DRUG STUDY

DATEORDERED MEDICATION DOSAGE FREQUENCY DATE GIVEN

11/25/09

Cefazolin 2g TID 9:25pm

11/25/09

Diphenhydramine 50mg 1 10:40pm

11/25/09

11/26/09

Ketorolac

Ranitidine

Initial Dose: 30mg

Second Dose: 15mg

50mg

q 8 x 2 more doses

Q8 x 3 more dose

2:00am

8:00 am

11/26/09 Tranexamic Acid 50mg q 8 x 3 more doses 7:00am

11/27/09 Co-amoxiclav

Ferrous Sulfate

Mefenamic acid

625g/tb

1tb

500mg /cap

BID

BID

q 8

27

DRUG INDICATIONS CONTRAINDICATION ADVERSE EFFECT NURSING CONSIDERATIONS

Generic Name:

Ranitidine

Hydrochlorid

Brand Name:

Zantac

Class:

Histamine2

antagonists

DOSE

50 mg q 8 hrs

ROUTE

IV

Short-term treatment of

active duodenal ulcer

Short-term treatment of

active, benign gastric

ulcer

Maintenance therapy

for duodenal ulcer atreduced dosage.

Short-term treatment for

GERD.

Pathologic

hypersecretory

conditions (Zollinger-

Ellison syndrome)

Treatment of erosive

esophagitis

Treatment of heartburn,

acid indigestion, sour

stomach

Contraindicated with

allergy to ranitidine,

lactation

Use cautiously with

impaired renal or hepatic

function, pregnancy

.

CNS: headache, malaise,

dizziness, somnolence,

insomnia, vertigo

CV: tachycardia,

bradycardia

Dermatologic: rash,

alopecia

GI: constipation, diarrhea,

nausea and vomiting,

abdominal pain, hepatitis

GU: impotence or

decreased libido

Hematologic: leucopenia,

granulocytopenia,

thrombocytopenia,

pancytopenia

Assessment:

1. History: allergy to ranitidine, impaired

renal or hepatic function, lactation,

pregnancy.

2. Physical: skin lesions, orientation, affect,

liver evaluation, abdominal examination,

normal output, renal function tests, CBC

Interventions:

1. Administer oral drug with meals and at

bedtime.

2. Decrease doses in renal and liver failure.

3. Provide concurrent antacid therapy to

relieve pain.

4. Administer IM dose undiluted, deep into

large muscle group.

5. Arrange for regular follow-up including

blood test, to evaluate effects.


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Case Presentation

Abruptio Placenta

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Case Presentation

Abruptio Placenta

DRUG INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING CONSIDERATIONS


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Generic Name:

Ketorolac

Tromethamine

Brand Name:Toradol

Class:

Analgesic

DOSE

30 mg q6

ROUTE

IV

Short-term

management of pain

(up to 5 days)

Ophthalmic: relief ofocular itching due to

seasonal

conjunctivitis and

relief of post-

operative

inflammation after

cataract surgery.

Contraindicated with

significant renal impairment,

during labor and delivery,

lactation, aspirin allergy,

recent GI bleed or perforation

Use cautiously with impaired

hearing; allergies; hepatic

conditions

CNS: headache,

dizziness,

somnolence,

insomnia, fatigue,

dizziness, tinnitus,ophthalmologic effects

Dermatologic: Rash,

pruritus, sweating, dry

skin

EENT: eye irritation,

dry eyes,

conjunctivitis, blurred

vision

GI: Gastric pain,

flatulence,

constipation, diarrhea,

nausea, vomiting,

anorexia, ischemic

colitis, renal and

mesenteric arterial

thrombosis,

retroperitoneal fibrosis,

hepatomegaly, acute

pancreatitis

GU: Impotance,

decreased libido,

peyronies disease,

dysuria, nocturia,

polyuria, priapism,

urinary retention

Assessment:

1. History: renal impairment, impaired hearing,

allergies, hepatic, lactation, pregnancy

2. Physical: skin color and lesions, orientation,

reflexes, peripheral sensation, clotting times,

CBC, adventitious sounds

Interventions:

1. Be aware that patient may be at risk for CV

events, GI bleeding, renal toxicity, monitor

accordingly.

2. Do not use during labor, delivery, or whilenursing.

3. Keep emergency equipment readily available

at time of initial dose, in case of severe

hypersensitivity reaction.

4. Protect drug vials from light.

5. Administer every 6 hrs to maintain serum

levels and control pain.


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RESPIRATORY:

Bronchospasm,

dyspnea, cough,

bronchial obstruction,

nasal stuffiness,rhinitis, pharyngitis

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Case Presentation

Abruptio Placenta

DRUG INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING CONSIDERATIONS

GenericName:

FerrousSulfate

Brand Name:

Fer-gen-sol

Class: ironpreparation

DOSE

ROUTE

Oral

.Prevention andtreatment of irondeficiencyanemias

Dietarysupplement foriron

Unlabeled use:Supplemental useduring epoetintherapy to ensureproperhematologicresponse toepoetin

Contraindicated withallergy to any ingredient;sulfite allergy;hemochromatosis,hemosiderosis, hemolyticanemias

Use cautiously withnormal iron balance;piptec ulcer, regionalenteritis, ulcerative colitis.

CNS: CNS toxicity,acidosis, coma anddeath withoverdose

GI: GI upset,anorexia, nausea,vomiting,constipation,diarrhea, darkstools, temporarystaining of theteeth (liquidpreparations)

Assesement

Allergy to any ingredient, sulfite;hemochromatosis, hemosiderosis,hemolytic anemias; normal iron balance;peptic ulcer, regional enteritis, ulcerativecolitis

PHYSICAL: Skin lesions; color; gums; teeth(color); bowel sounds; CBC, Hgb, Hct,serum ferritin and iron levels

Interventions:

Confirm that patient does have irondeficiency anemia before treatment.

Give drug with meals(avoiding milk, eggs,coffee, and tea) if GI discomfort is severeand slowly increase to build up tolerance.

Administer liquid preparations in water orjuice to mask the taste and preventstaining of teeth; have the patient drinksolution with a straw.

Warm patient that stool may be dark orgreen.

Arrange for periodic monitoring of


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hematocrit and hemoglobin levels

31

Case Presentation

Abruptio Placenta



37/45

Generic Name:

TRANEXAMI

C ACID

Brand Name:

Cyklokapron

Class:

Antifibrinolyticagent

DOSE

10 mg/kg (usual500-1000 mg) IV2-4 times daily

ROUTE

IV

1.treatment ofexcessivebleeding resultingfrom systemic orlocal

hyperfibrinolysis

2.prophylaxis inpatients withcoagulopathyundergoingsurgicalprocedures

Acquired defective

color vision; active

intravascular

clotting;

subarachnoidhemorrhage;

concurrent factor IX

complex or anti-

inhibitor coagulant

concentrates

Postmarketing and/orcase reports: Deepvenous thrombosis(DVT), pulmonary

embolus (PE), renalcortical necrosis,retinal arteryobstruction, retinalvein obstruction,ureteral obstruction

Assessment:

Dosage modification required in patients

with renal impairment; ophthalmic exam

before and during therapy required if patientis treated beyond several days;

caution in patients with cardiovascular,

renal, or cerebrovascular disease; caution in

patients with a history of thromboembolic

disease (may increase risk of thrombosis);

when used for subarachnoid hemorrhage,

ischemic complications may occur

Intervention:

1.Monitor patient closely for increased risk

of thromboembolic complications.

2.Severe and sometimes fatal

thromboembolic events have been reported

in APL patients receiving the combination

32

Case Presentation

Abruptio Placenta



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GENERIC

NAME:

MEFENAMIC

ACID

BRAND

NAME:

PONSTEL

Class:

anti-pyretic

DOSE:

500 mg tid

ROUTE:

ORAL

>used for therelief of mild tomoderate pain in

acute and chronicconditionsincluding: pain oftraumatic, arthriticor muscular origin;dysmenorrhoea;headache anddental pain.

> reduces bloodloss in

menorrhagiawheremenorrhagia is dueto ovulatorydysfunctionalbleeding. Uterineand otherpathology shouldfirst be excludedbefore prescribingMefenamic acid for

this indication.

>contra-indicated

in patients with

known sensitivityand in patients who

respond to aspirin

and aspirin-like

medicines with

sensitivity reactions

like

bronchoconstriction

, skin rashes and

urticaria.

> contra-indicated

in patients with

peptic ulceration or

having a history of

gastro-intestinal

bleeding and or

inflammatory bowel

disease.

CV:thromboticevents,myocardialinfarction, and

stroke, which canbe fatal

GI: Risk ofUlceration,Bleeding, andPerforation

Assessment:

Assess patient pain before therapy

Monitor for possible drug inducedadverse reaction

Advice patient not to take drug

for more than 7 days

Intervention:

>Patients should promptly report signs orsymptoms of unexplained weight gain or

edema to their

>Patients should be informed of the warning

signs and symptoms of hepatotoxicity (e.g.

nausea, fatigue, lethargy, pruritus, jaundice,

right upper quadrant tenderness, and "flu-like"

symptoms

>Patients should be informed of the signs ofan anaphylactoid reaction (e.g. difficulty

breathing, swelling in the face or throat. 33


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Case Presentation

Abruptio Placenta

VIII. NURSING CARE PLAN

ASSESSMENT NURSING

DIAGNOSIS

PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE:

masakit yung tahi ko,makirot siya. Asverbalized by thepatient.

OBJECTIVE:

- facial grimacing

- frequentabdominalguarding

- pain scale, asrates pain as 7,10 as the most

painful and 1 asthe least painful

- restlessness

Altered Comfort:Pain related tosurgical incision asevidenced byabdominal guarding,pain scale of 7/10.

RATIONALE:

Patients commonlyprovide security tothe muscle in pain bguarding it for thisgives them theassurance that painwill not furthercomplicate.

With in 2 hours ofnursing intervention thepain will be reduced asevidenced by:

1. Pain scale,rates pain as 3,10 as the mostpainful and 1 asthe leastpainful.

2. Decreaseabdominalguarding.

3. Decrease facialgrimacing

4. Verbalizationthat pain isreduced

Independent:

1. Providedalternativediversions

2. Monitor vitalsigns every 30mins.

3. Encouragepatient ofverbalizationof pain

Dependent:

1. Assistedpatient indrinkingmedicationsas ordered bythe physician

1. Diverts patientsattention to painand makes thisas copingmechanism

2. Provides abaseline dataand note for

certain changesthat mightmanifest furtherabnormalities

3. Providesimmediate careto avoid furthercomplications

1. Administerpainmedicationas orderedby theDoctor

After 2 hours of nursingintervention the patientspain was reduced asevidenced by:

1. Pain scale, rates

pain as 5, 10 asthe most painfuland 1 as the leastpainful.

2. Decreasedabdominalguarding

3. Distraction of ownself. Reduces painperception

4. To monitor

significant changes

Goal partially met


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Case Presentation

Abruptio Placenta

ASSESSMENT NURSINGDIAGNOSIS

PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE:

mainit angpakiramdam ko,parang nilalagnatako.

OBJECTIVE:

- teary eyes

- warm totouch

- V/S takenTemperature: 38C

Fever related toallergic reaction inBlood Transfusion asevidenced by increase

of temperature (38c)

RATIONALE:

Anything foreignsubstance thatintroduced into thebody may causeallergic reaction thatmay affect well-being ifan individuals.

With in 1 hour ofnursing interventionfever will decrease

from 38C to 37.0C

1. Perform TSB2. Give

paracetamoltablet asordered.

Independent:

1. Perform TSB

2. Continuousmonitoring of V/S.

Dependent:

1. Discontinue Blood

Transfusiontemporarily.Substitute PNSSuntil the feversubside thencontinue BloodTransfusion

2. Paracetamol givenas ordered by thedoctor.

Independent:

1. To decreasetemperature ofthe patient

2. Provide as abaseline dataand note forcertain

changes thatmight manifestfurtherabnormalities

Dependent:

1. Blood Transfusion isa foreign substancethat could cause anallergic reaction to the

client. PNSS

2. To decreasetemperature of thepatient.

After 1 hour ofnursingintervention thepatients feverwas decreasedas evidenced by:

1.Temperature

of the patientsubsided from

38c to 36.5c

Goal met


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Case Presentation

Abruptio Placenta

ASSESMENT NURSINGDIAGNOSIS

PLANNING INTERVENTION

RATIONALE EVALUATION


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SUBJECTIVE:

-Patientverbalized,Sabi patay nadaw ang anakko.

OBJECTIVE:

-facial tension-voicequivering-trembling/handtremors

Anxiety relatedto death of herson asevidenced bycrying.

Rationale:

Anxiety isrelated to thenarrowing of thepersonsperception ofthe situation.

The personsfocus is limitedto the specific

details of thesituation

Short term

With in 3 hours ofNursing care, thepatient will manifestreduced anxiety asevidenced by:

1.Px demonstratingpositive copingmechanisms.

2.activeparticipation andfocus in instructionsgiven

3.verbalization of

positive thoughts orplans afterhospitalization

Long Term:

With in a week ofnursing interventionpatient will be ableto cope and surpassthe DABDA stages

Diagnostic:

1.Assesedpatients level ofanxiety

Therapeutic:

2. established agood workingrelationship withthe px throughcontinuity ofcare.

3.encouragedpx verbalizationof thoughts and

feelings

Educative:

4. Assisted thepx inrecognizingsymptoms ofincreaseanxiety.

1.To determinethe level ofanxiety and

1. Knowing the levelof anxiety enhancesthe patientsawareness andability to identifyand solve problems.

2. on goingrelationshipestablishes a basisfor comfort incommunicatinganxious feelings.

3. talking aboutanxiety-producingsituations and

anxious feelings canhelp the personperceive thesituation in a lessthreatening manner.Expressing emotionscan enhance the pxcoping strategies.

1.to identifypatientsimprovement on thecoping mechanism.

After 3 hours ofNursing care, the wasable to demonstratepositive copingmechanisms andreduced anxiety asevidenced by:

1. Being able to focuson instructions givenand putting them intoaction in the outmostway the patient can.

2.Verbalization thatthere might be biggerproblems that can

arise and verbalizingthat she is still luckenough to have the lifethat she has now.

3. Being spirituallyhealthy as evidencedby having periods forprayer.

1. Partially met dueto lack of time indoing thenursing


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Case Presentation

Abruptio Placenta

IX. DISCHARGE PLAN

Objectives:

This plan aims to continue treatment and care to the patient by involving significant others to participate plan of

care.

Medications:

Instruct patient to continue her prescribed medicines.


44/45

Treatment:

Instruct patient straineous activity

Health Teaching:

Instruct the patient to clean her wound and change dressing everyday.

Out patient

Follow up appointment

Diet

DAT, Increase fluid intake

Case Presentation

Abruptio Placenta

X. BIBLIOGRAPHY

Sherwin N uland, MD, Bernadine Healy M.D , Susan G. Braun ( 1997) Merck Manual of Medical Information,Home Edition ( Publihed by Merck + company Inc.

Wolff, Weitzel, Zornow, Zsohar (Seventh Edition) Fundamental of Nursing Publishedby J.B Lippincott

company Philadelphia

Barbara Kozier, Glenona Erb, Audrey berman, Shirlee Snyder (2004) Fundamentals of Nursing Concepts,

Process + Practice ( Sevent Edition) Published by Pearson Education South Asia Pte. Ltd.


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Marilyn E. Doenges, Mary Frances, Moor house, Alice C. Murr (2004) Nurses Pocket Guide ( Ninth Edition)

Published by Robert G. Mar tone.

Lippincott Williams + Wilkins (2006 ) Nursing Drug handbook(26th edition) Pblished by Walters Kluwer

Company.

bleeding love manuscript

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