Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna

College of Nursing and Allied Health

A MINI CASE STUDY ON

ABRUPTIO PLACENTA
Nursing Care Management 106 Related Learning Experience (RLE)

Submitted by: Submitted to:

Airalyn C. Alaro BSN 4A Elenita S. Carandang, M.S.N.
 OVERVIEW OF THE DISEASE

Pre-eclampsia
Pre-eclampsia is the presence of hypertension and proteinuria occurring after the 20th
week of gestation except in cases of extensive trophoblastic proliferation. Pre-eclampsia has
been further classified as severe in the presence of one or more of the following signs and
symptoms.
Signs and Symptoms Mild Preeclampsia Severe preeclampsia
Blood Pressure 140/90 or higher, or an 160/110, or an increase of
increase of 30 mmHg in greater than 30 mmHg in
systolic pressure and 15 mmHg systolic pressure and greater
increase in diastolic pressure than 15 mmHg
Edema Mild to moderate edema of Severe edema of hands and
hands and face (+1 or +2) face (+3 to +4), including
cerebral edema
Proteinuria Greater than 0.3g 1g/L/24- G5.L/24-hour urine or more
hour urine (+1 to +2) (+3 to +4)
Weight gain Greater than 1lb/week Equal to or greater than
5lb/week

Premature Separation of the Placenta (Abruptio Placentae)

In premature separation of the placenta (also called abruption placentae), the
placenta appears to have been implanted correctly. Suddenly, however, it begins to separate
and bleeding results. This occurs in about 10% of pregnancies and, because it can lead to
extensive bleeding, is the most frequent
cause of perinatal death. The separation
generally occurs late in pregnancy, even as
late as during the first or second stage of
labor. Because premature separation of the
placenta may occur during an otherwise
normal labor, it is important to always be
alert to both the amount and kind of pain and
vagina bleeding a woman is having in labor.
 The primary cause of premature separation is unknown, but certain predisposing
factors are high parity, advanced maternal age, a short umbilical cord, chronic hypertensive
disease, hypertension of pregnancy, direct trauma (as from an automobile accident or intimate
partner violence), vasoconstriction from cocaine or cigarette use, and thrombophilitic
conditions that lead to thrombosis formation. It also may be caused by chorioamnionitis or
infection of the fetal membranes and fluid.
Yet another possible cause is a rapid decrease in uterine volume, such as occurs with
sudden release of amniotic fluid. Usually, the fetal head is low enough in the pelvis that when
membranes rupture, this prevents loss of the total volume of amniotic fluid at one time, so
normally a rapid reduction in amniotic fluid does not occur.

Assessment
A woman experiences a sharp, stabbing pain high in the uterine fundus as the initial
separation occurs. If labor begins with the separation, each contraction will be accompanied
by pain over and above the pain of the contraction. Tenderness can be felt on uterine
palpation.
Heavy bleeding usually accompanies premature separation of the placenta, although it
may not be readily apparent. External bleeding will only be evident if the placenta separates
first at the edges, so blood escapes freely into the uterus and then the cervix. In contrast, if the
center of the placenta separates first, blood can pool under the placenta, and although
bleeding is just as intense, it will be hidden from view. Whether blood is evident or not, signs
of hypovolemic shock usually follow quickly. The uterus becomes tense and feels rigid to the
touch. If blood infiltrates the uterine musculature, Couvelaire uterus or uteroplacental
apoplexy, form a hard, boardlike uterus occurs. As bleeding progresses, a womans reserve of
blood fibrinogen becomes diminished as her body attempts to accomplish effective clot
formation, and DIC syndrome can occur.
If a woman is being admitted to the hospital after experiencing symptoms at home,
assess when the time the bleeding began, whether pain accompanied it, the amount and kind
of bleeding, and her actions to detect if trauma could have led to the placental separation.
Initial blood work should include hemoglobin level, typing and cross-matching, and a
fibrinogen level and fibrin breakdown products to detect DIC.
 PATIENTS PROFILE

Hospital Number: 1611036

Patients Name: Bunyi, Hersey Dayo
Address: #108 Brgy. San Nicolas, San Pablo, Laguna
Sex: Female
Civil Status: Married
Birthdate: 02/26/1979
Age: 38 yo
Birthplace: San Pablo, Laguna
Nationality: Filipino
Religion: Iglesia Ni Cristo

Admission Date: 09/23/2017

Admission Time: 11:30 AM
Admitting Physician: Lina Felicidad E. Candido, M.D.
Admitting Diagnosis: G3P2 36-37 weeks
Pre-eclampsia Severe
Principal Diagnosis: PU Full Term Delivered via Emergency LTCS (3x) due to Abruptio
Placenta
Other Diagnosis: Low birth weight G3P3 (3003)
Procedure: Caesarean
Chief Complaint: Her reason why she was admitted to the hospital is she saw a moderate
bleeding from her vagina and felt severe pain on her low back and abdomen with rapid
comtractions on her uterus
 PATIENTS HISTORY

A. Present Health History

Last September 23, 2017, at 9 oclock in the morning, while the patient was watching
television she suddenly saw moderate bleeding from her vagina and felt severe pain on her
low back and abdomen with rapid contractions on her uterus. Her husband decided to rush
her to Panlalawigan Pagamutan ng Laguna San Pablo. There, her blood pressure was taken
to be at 190/120 mmHg, she was then admitted that day. Due to her high blood pressure, the
physician then decided that the patient needed to undergo surgery and was scheduled that
night. During surgery, her blood pressure was 170/100 mmHg. By 10:23 PM, she delivered a
baby girl weighing 2310 g, which is a low birth weight. The patient was confined on the
second day when she was handled by the student nurse.

B. Past Health History

The patient undergone cesarean section on her first baby back in 2012 due to a large
baby or macrosomia. Her second pregnancy happens in 2014 wherein she undergone
cesarean section for the second time for the reason that she had hypertension or elevated
blood pressure than normal range during her stage of labor. According to her, she never was
hypertensive back when she was young but by the time she had her second baby, her blood
pressure gradually increases from time to time.
 PHYSICAL ASSESSMENT

AREA FINDINGS INTERPRETATION

NEUROLOGIC Patient is awake, responds

immediately and Normal

Level of consciousness appropriately to all verbal

stimuli.

AREA METHOD FINDINGS INTERPRETATION

INTEGUMENTARY Inspection and Pallor This is due to the

Skin palpation Skin color is tan. blood loss during the

post surgical

procedure/post

caesarean delivery

Poor skin turgor In the presence of

excess of interstitial

fluids on area of
 edema becomes dry

and shiny

Absence of lesions Normal

and masses on the

surface of the skin.

Hair Inspection Hair color is black Normal

with smooth and

fine hair strands and

is equally

distributed.

Nails Inspection Pale nail beds This is due to the

blood loss during the

post surgical

procedure/post

caesarean delivery

Capillary refill time This is manifested of

3-4 sec. decrease level of

RBCs due to edema

HEAD

Skull and Face Inspection and Head is of regular Normal

palpation shape with no

 apparent lesions,

masses or foreign

bodies. Scalp no

evidence of skin

condition or

infestation, and

exhibited no

tenderness on

palpation.

Eyes and Vision Inspection Eyes are aligned; Normal

eyebrows are free of

scaling.

There is presence of Increased interstitial

facial and fluid d/t odium &

periorbital edema. water retention in

areas where the tissue

pressure is low, the

areas become more

permeable, allowing

fluid to escape into

interstitial tissues.
 Extra ocular Normal

movement (EOM) is

intact.

No evidence of

increased tearing.

Pupils are equally

rounded, reactive to

light and

accommodation.

Pale conjunctiva This is due to the

blood loss during the

post surgical

procedure/post

caesarean delivery

Ears and Hearing Inspection and Symmetrical ears Normal

palpation and equal in size

aligned on the outer

canthus of the eye.

No presence of

tenderness, masses

and

drainage/clogged
 cerumen. Pinna

recoils immediately.

Nose and Sinuses Inspection and Nose is midline on Normal

palpation the face without

swelling, bleeding

or lesions. Patient

can breathe

normally in both

nostrils. No

presence of

discharge, bumps

and tenderness; no

pain reported.

Mouth and Inspection Lips, oral mucosa This is due to the

Oropharynx and gums are pale in blood loss during the

color. post surgical

procedure/post

caesarean delivery

No suspected Normal

lesions or masses on

tongue, gums, hard

and soft palate and

tonsils. Uvula is in
 the middle; tonsils

are pink without

hypertrophy.

Tongue easily move

in all directions.

With intact gag Normal

reflex

Trachea and Palpation Trachea in midline Normal

thyroid gland position.

Thyroid gland lobe Normal

non- palpable, no

evidence of

enlargement and

rises as patient

swallows.

Lungs Percussion and Thorax rise and fall Normal

palpation with inspiration and

expiration. Resonant

percussion

throughout. Breath
 sounds normal with

no extra sounds.

Cardiovascular Palpation and No extra heart Normal

System auscultation sounds and no

murmurs heard. No

jugular vein

distention at 45

degrees. Point of

maximal impulse

(PMI) palpable in

5th ICS, MCL left

border of sternum.

Aortic pulsation

normal, no bruits

sounds.

Capillary refill of This is manifested of

nail beds 3-4 decrease level of

seconds RBCs due to edema

Breast and Axillae Inspection Breast is smooth, no Normal

dimpling and the

same color of the

skin

No edema noted
 With breast

asymmetry on left

side

No lesion seen

No palpable mass

No breast

engorgement

Uterus Inspection Uterus is midline Normal

Palpation Uterus is firm,

globular and

contracted

With periumbilical

incision

Bladder Palpation Bladder is not The patient have a

distended foley catheter

Bowel Movement Observation With positive bowel Normal

movement

With positive flatus

Lochia discharge Inspection Reddish in color Normal

Incision Inspection Dry and intact Normal

Extremities Inspection There is edema seen Due to sodium

on both extremities retention and high

blood pressure
 Abdomen Inspection, No tenderness to Normal

auscultation, palpation. Normal

percussion and bowel sounds with

palpation findings of;

RLQ: 3 per min

RUQ: 4 per min

LUQ: 4 per min

LLQ: 3 per min

Rectum/ Anus Inspection --- ---

 DRUG STUDY

Name of the Dosage and Classification Mode of Indication / Side Effects or Nursing Responsibilities
Drug Frequency Action Contraindication Adverse Effect
Generic 5 mg IM on Therapeutic Replaces Indication: CNS: toxicity, Monitor patient closely
name: buttocks class: magnesium and Seizures in weak or absent during and following
magnesium 4 mg IM on Electrolyte maintains pre- DTRs, flaccid infusions.
sulfate buttocks replacements magnesium eclampsia paralysis, Observe orthostatic
level; as an or drowsiness, precautions.
Brand anticonvulsant, eclampsia stupor
name: reduces muscle Contraindication CV: slow, weak
Sulfamag contractions by Hypermagn pulse;
interfering with esemia arrhythmias;
release of Heart block hypotension;
acetylcholine at Myocardial circulatory
myoneural damage collapse; flushing
junction. Active GI: diarrhea
labor or Metabolic:
within 2 hypocalcemia
hours of Respiratory:
delivery respiratory
paralysis
Skin: diaphoresis
Other:
hypothermia
Generic 50 mg TIV Therapeutic Unknown. A Indication: CNS: peripheral Monitor patients BP and
name: q4 class: direct-acting Essential neuritis, pulse rate. Hydralazine
hydralazine PRN for BP antihypertensi peripheral hypertensio headache, may be given with
>140/90 ve vasodilator that n dizziness diuretics and beta-
Brand relaxes Contraindication blockers to decrease
name: sodium retention.
Alphapress arteriolar Hypersensi GI: nausea,
smooth muscle. tive to drug vomiting,
CAD constipation
Generic 1.5 mg TIV Therapeutic Inhibits cell- Indication: CV: phlebitis, Monitor patient for signs
name: (-) ANST class: wall synthesis, Skin or thrombophlebitis. and symptoms of
cefuroxime 750 mg TIV antibiotics promoting skin- GI: diarrhea, superinfection and
q8 x 3 doses osmotic structure pseudomembrano diarrhea.
Brand instability; infections us colitis, nausea, Instruct patient to notify
name: usually Contraindication: anorexia, prescriber about rash,
Cefumin bactericidal. Contraindic vomiting. loose stools, diarrhea, or
ated in Hematologic: evidence of
patients haemolytic superinfection.
hypersensiti anemia, Advise patient receiving
ve to drug or thrombocytopenia drug IV to report
other transient
cephalospori
discomfort at IV
neutropenia, insertion site.
ns.
eosinophilia.
Skin:
maculopapular
and erythematous
rashes, urticaria,
pain, induration,
sterile abscesses,
temperature
elevation.
Other:
anaphylaxis,
hypersensitivity
reactions, serum
sickness.
Generic 20 mg TIV Therapeutic Inhibits sodium Indication: CNS: vertigo, Monitor patients weight,
name: now class: and chloride Edema headache, BP, and pulse rare
furosemide antihypertensi reabsorption at Hypertensi dizziness routinely
ve the proximal on CV: orthostatic Monitor fluid intake and
Brand and distal Contraindication hypotension output and electrolyte,
name: Pharmacolog tubules and the Hypersensi EENT: transient BUN, and carbon dioxide
Lasix ic class: loop ascending loop tive to drug deafness levels frequently.
diuretics of Henle. GI: abdominal Watch out for signs of
discomfort, hypokalemia, such as
nausea, vomiting, muscle weakness and
constipation cramps.
GU: nocturia
Hematologic:
thrombocytopenia
Hepatic: jaundice
Musculoskeletal:
muscle spasm
Other: gout
Generic 1 tab OD Therapeutic Elevates the Indication: Dizziness, nasal Advise patient to take
name: class: iron serum iron Prevention congestion, medicine as prescribed.
ferrous preparation concentration and dyspnea, Caution patient to make
sulfate which helps to treatment hypotension, position changes slowly
form a high or of iron muscle cramps, to minimize orthostatic
Brand trapped in the deficiency flushing hypotension.
name: reticuloendothel anemia Encourage patient to
Brisofer ial cells for Dietary comply with additional
storage and supplement intervention for
eventual for iron hypertension like proper
conversion to a Contraindication diet, regular exercise,
usable form of Hypersensi lifestyle changes and
iron. tive to drug stress management.
 Severe
hypotensio
n
Generic 10 mg 1 tab Therapeutic Inhibits calcium Indication: CNS: headache, Monitor patient carefully.
name: OD class: ion influx Hypertensi somnolence, Monitor BP frequently
amlodipine antihypertensi across cardiac on fatigue, dizziness during initiation of
ve and smooth Contraindication CV: edema, therapy.
Brand muscle-cells, Hypersensi flushing,
name: dilates coronary tive to drug palpitations
Norvasc arteries and GI: nausea,
arterioles, and abdominal pain
decreases BP
and myocardial
oxygen
demand.
 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: Nahihilo ako Hypertension Short-term: Independent: The patient will be
as verbalized by r/t dizziness as Within the Monitor vital signs. To obtain baseline data. able to maintain
the patient manifested by 4hrs of shift, Observe skin color, Presence of pallor; cool, BP within
BP of 150/90 the patient will moisture, moist skin; and delayed individually
BP: 150/90 verbalize no temperature, and capillary refill time may acceptable range.
mmHg dizziness. capillary refill be due to peripheral
Temp: 36.6 time. vasoconstriction or reflect
C Long-term: cardiac
PR: 87 bpm Within the decompensation/decreased
RR: 22 8hrs of duty, output.
Generalized the patient will
be able to Provide calm, Helps reduce sympathetic
pallor
decrease the restful
Body surroundings,
stimulation that promotes
malaise blood pressure relaxation.
to 130/70 or minimize
Periorbital environmental
less.
and activity/noise.
peripheral Limit the number
edema of visitors and
length of stay.
Implement dietary
sodium, fat, and These restrictions can help
cholesterol manage fluid retention
restrictions as and, with associated
indicated. hypertensive response,
decrease myocardial
workload.
Dependent:
Administer A direct-acting peripheral
prescribed vasodilator that relaxes
medication as order arteriolar smooth muscle.
such as:
o Hydralazine
50 mg TIV
PRN for BP
> 140/90