Name: Sumbad, Mark Bhen E.

NBA-2

ACTIVITY 2
Problems with the Placenta and Cord
CASE STUDY #4
A 22 Y/O G2P1, cocaine user at 35 weeks AOG complains of abdominal pain and
moderate vaginal bleeding. On examination, her blood pressure is 150/90mmHg,
HR=110bpm. The fundus reveals tenderness. The ultrasound is normal. The fetal
heart tone is 160-170pbm range.
1. WHAT PROBLEMS WITH THE PLACENTA IS THE CLIENT EXPERIENCING?
- The client is experiencing Premature Separation of the Placenta (Abruptio
Placentae). It is the early separation of a placenta from the lining of the uterus
before completion of the second stage of labor. It is one of the causes of bleeding
during the second half of pregnancy. Placental abruption is a relatively rare but
serious complication of pregnancy and placed the well-being of both mother and
fetus at risk. Placental abruption is also called abruptio placentae.
WHICH OF THE FOLLOWING IS MOST LIKELY TO BE PRESENT IN HER DRUG
SCREEN?
A. Marijuana
B. Alcohol
C. Cocaine
D. Barbiturates

2. WHAT IS THE BEST MANAGEMENT FOR THIS CONDITION?

- A woman needs a large-gauge intravenous catheter inserted for fluid
replacement and oxygen by mask to limit fetal anoxia.
- Monitor fetal heart sounds externally and record maternal vital signs every 5 to 15
minutes to establish baselines and observe progress.
- The baseline fibrinogen determination is followed by additional determinations up
to the time of birth.
- Keep a woman in a lateral, not supine, position to prevent pressure on the vena
cava and additional interference with fetal circulation
- The degrees of placental separation can be graded. Unless the separation is
minimal (grades 0 and 1), the pregnancy must be terminated because the fetus
cannot obtain adequate oxygen and nutrients. If vaginal birth does not seem
imminent, cesarean birth is the birth method of choice.
- If Disseminated Intravascular Coagulation (DIC) has developed, cesarean
surgery may pose a grave risk because of the possibility of hemorrhage during
the surgery and later from the surgical incision.
- Intravenous administration of fibrinogen or cryoprecipitate (which contains
fibrinogen) may be used to elevate a woman’s fibrinogen level prior to and
concurrently with surgery.
- With the worst outcome, a hysterectomy might be necessary to prevent
exsanguination.
- Needs to be observed closely for the development of infection in the postpartum
period.

NURSING CARE OF THE HIGH-RISK POSTPARTUM CLIENT

CASE STUDY #5
A 35 Y/O G5P4 woman at term with a prior history of a myomectomy and CS is
undergoing a vaginal delivery. The retained placenta is firmly adherent to the uterus
when there is an attempt at manual extraction

1. WHAT IS THE MOST LIKELY PROBLEM OF THE PLACENTA ENCOUNTERED

BY THE ABOVE CLIENT?
 - The problem of the placenta encountered by the client is called Placenta
accreta. Typically, the placenta detaches from the uterine wall after childbirth.
With placenta accreta, part or all of the placenta remains attached. 
.
2. WHAT IS THE BEST MANAGEMENT FOR THIS CONDITION?
- The best management for this condition is Hysterectomy or treatment with
methotrexate to destroy the still-attached tissue.

CASE #6
A 31 Y/O G4P3 woman has a normal vaginal delivery of her baby. On examination, her
HR=100bpm and RR=12bpm. Her heart and lung examinations are normal. The right calf
is somewhat tender and slightly swollen. She has positive Homan’s sign.

1. WHAT IS MOST LIKELY THE CLIENT IS SUFFERING FROM?

- The client is suffering from inadequate peripheral circulation resulting to
thrombophlebitis by dorsiflexing a woman’s ankle and calf is somewhat tender
and slightly swollen (positive Homan’s sign).

2. WHAT DRUG IS BEST FOR THIS CONDITION?

- Activated partial thromboplastin time (aPTT) or prothrombin time (PT) is obtained.
- Heparin, an anticoagulant, can be administered by continuous intravenous
infusion or intermittently by intravenous or subcutaneous injection.

3. GIVE 2 HEALTH TEACHINGS FOR THE CLIENT IN MANAGING THE PROBLEM

- Inform the client that heat supplied by a moist, warm compress can help
decrease inflammation.
- Emphasize the importance of bed rest and elevate affected legs to decrease the
sensitivity of the leg and to improve circulation