RAD RLE Guide -Written Requirements

Name of Student : Piczon, Jackielyn Rose P.

Section : BSN2 – A6
Concept : Taking care of the Mother
Name of Clinical Instructor : Sir Billy Ray Adraneda Marcelo
Patients Data:
Name: Grace Marie Torres Renegado
Gender: Female Occupation: Businesswoman
Birth Date: January 8, 1994 Nationality: Filipino
Birth Place: Talisay City ____
Religion: Roman Catholic
Age: 26
Address: Pook, Talisay City, Cebu
Source of Data: Patient’s Chart
_______
Educational Level : Date & Time of Admission: 6/17/20, 5:09 AM
Marital Status: Married Attending Physician: Dr. Ubal
_
Diagnosis: G₁P₁ PU 39 ⁴/₇ weeks AOG,
Cephalic in labor, PROM 6 cm -dilated epilepsy

Chief Complaint: Watery Vaginal Discharge

LMP : 9/13/19
AOG : 39 ⁴/₇ weeks
EDC : 6/20/20
VITAL SIGNS: BP: 130/80 Temperature: 37.1 Pulse Rate: _92 RR: 24 O2
Saturation: 98%
Weight: 117 lbs

Brief History Upon Admission:

G₁P₀ Pregnancy Uterine 39 ⁴/₇ weeks AOG, cephalic, in labor
GDM- diet controlled
Epilepsy
FH – 20 cm
FHT – 140
EFW – 2, 945 gms
6 cm dilated. 80% eff.
S: 5 hours PTA, Patient noted sudden onset of watery vaginal discharges, clear associated with
intermittent hypogastric pain,
every 5-10 minutes thus consult.

Admitting Diagnosis: G₁P₁ PU 39 ⁴/₇ weeks AOG, Cephalic in labor, PROM 6 cm -dilated epilepsy
 Anatomy & Physiology
(This will show a drawing of the organ affected related to the diagnosis of the patient.)

Parts of the organ and functions of each part:

UMBILICAL CORD- also called as supply line since it carries the baby’s blood back and forth. It forms 5 weeks after
conception. The function of the umbilical cord delivers oxygen and nutrients to the baby and also remove waste products.

UMBILICAL VEIN- found in umbilical cord that carries oxygenated, nutrient-rich blood from the placenta to the baby.

Umbilical arteries- also found in the umbilical cord that carries deoxygenated, nutrient- depleted blood from the
fetus to the placenta for replenishment.

CHORIONIC VILLUS- tiny looking fingers projection of placental tissue that increases the surface area to make products
available from maternal blood to the fetus.

PLACENTA- as the uterus grows, so does the placenta. In most cases, it is attached to the uterine wall at the top or side.
In addition to supplying oxygen and nutrients to the growing child, this structure also removes toxins from the blood.
During pregnancy, the placenta attaches to the uterine wall, and the baby's umbilical cord grows from it.

MATERNAL VEIN- vein-like structure; blood from the placenta is collected in the mother's veins, and as the blood passes
through her liver and kidneys, dissolved wastes, including those from the placenta, are excreted from the blood.

MATERNAL ARTERY- deoxygenated blood is pushed into the endometrium and uterine veins by the maternal arterial
blood, which then returns to the maternal circulation. In the fetal-placental circulation, deoxygenated and depleted fetal
blood is carried from the fetus to the villous core fetal vessels by umbilical arteries.

PLACENTAL SEPTUM- also known as desidual septum; one of the two cotyledon-producing decidual tissues that
protrudes from the placenta and divides it into cotyledons when it grows toward the chorionic plate.

INTERVILLOUS SPACE (LACUNAE)- space between chorionic villi that contains maternal blood.

MATERNAL PORTION OF PLACENTA- recognized as decidua basalis; known as maternal uterine tissue, the
decidua plays an important role in protecting the embryo from being attacked by maternal immune cells and
provides nutritional support for the developing embryo prior to placenta formation.

BASAL PLATE- that part of the neural tube which is located between the sulcus limitans and the beginning of the alisphenoid.
Numerous motor neurons are contained in the rostral mesencephalon to the end of the spinal cord, whereas sensory neurons are
mainly found in the alar plate.
UTERUS- a long hollow organ located between the bladder and rectum in the female pelvis; embryo develops into fetus
and continues to grow until childbirth. As well as supporting the bladder, bowel, and pelvic bones and organs, the uterus
also provides structural integrity and support. It separates the bladder from the intestines and the colon.

CHORIONIC PLATE- The fetal side of the placenta is known as the chorionic plate. This invades the endometrium and allow the
transfer of nutrients from maternal blood to fetal blood.

Definition of the disease:

Abruptio placentae, also known as placental abruption, occurs when the placenta partially or entirely separates from the
uterus, posing a danger of hemorrhage. This is most common between 24-26 weeks of pregnancy and is considered a
significant issue. In mild circumstances, the patient may be restricted to limited activity or bed rest for the duration of the
pregnancy, but in more severe cases, if there is maternal or fetal impairment, delivery is indicated. While most cases of
placental abruption occur suddenly, persistent abruption can occur when there is a tiny separation that causes continuous
bleeding beneath the placenta.
Additionally, epilepsy is a central nervous system (neurological) illness characterized by aberrant brain activity, resulting
in seizures or episodes of odd behavior, feelings, and, in some cases, loss of awareness. Epilepsy can affect everyone.
Epilepsy affects both men and women of various races, ethnicities, and ages.

Clinical Manifestation/Signs & Symptoms:

The most common symptom of placental abruption is painful, dark red bleeding from the vagina. It happens during the
third trimester of pregnancy. It also can occur during labor. Some women may not have vaginal bleeding that can be seen,
but there may be bleeding inside the uterus. Symptoms of placental abruption may include vaginal bleeding, pain in the
belly (abdomen), back pain, labor pains (uterine contractions) that do not relax, blood in the bag of water (amniotic fluid),
feeling faint and not feeling the baby move as much as before.
Furthermore, seizures can disrupt any process that your brain coordinates since epilepsy is caused by aberrant brain
activity. Temporary bewilderment, a staring spell, uncontrollable jerking motions of the arms and legs, loss of
consciousness or awareness, psychic sensations such as panic, worry, or deja vu are all signs and symptoms of a
seizure. The symptoms of a seizure differ depending on the type of seizure. A person with epilepsy will often experience
the same sort of seizure each time, therefore the symptoms will be identical from episode to episode. Seizures are
classified as either focal or generalized by doctors based on how the abnormal brain activity occurs.
Laboratory Test

Date Type of Patient’s Normal Significance / Interpretation

exam Result Values
6/17/20 Blood Blood type & Blood type & A, positive is one of the most
Typing Rh: O, Negative Rh: A, positive common blood types (35.7% of
the U.S. population has it).
Someone with this type can give
blood only to people who are A
positive or AB positive. People
with type A blood have anti-B
antibodies.
A, negative A, negative: Someone with this
rare type (6.3% of the U.S.
population) can give blood to
anyone with A or AB blood type.
People with type A blood have
anti-B antibodies.
B, positive B positive: Someone with this
rare type (8.5%) can give blood
only to people who are B positive
or AB positive. People with type
B blood have anti-A antibodies.
B, negative B negative: Someone with this
very rare type (1.5%) can give
blood to anyone with B or AB
blood type. People with type B
blood have anti-A antibodies.
AB, positive AB positive: People with this rare
blood type (3.4%) can receive
blood or plasma of any type.
They’re known as universal
recipients. Type AB contains
neither antigen.
AB, negative AB negative: This is the rarest
blood type -- only 0.6% of the
U.S. population has it. Someone
with this blood type is known as
a “universal plasma donor,”
because anyone can receive this
type of plasma. Type AB contains
neither antigen.
O, positive O positive: This is one of the
most common blood types
(37.4%). Someone with this can
give blood to anyone with a
positive blood type. Type O blood
contains both types of
O, negative antibodies.
O negative: Someone with this
rare blood type (6.6%) can give
blood to anyone with any blood
type. Type O blood contains both
types of antibodies. Pregnant
 women with a negative blood
type are sometimes at risk of Rh
incompatibility, and while this
used to be a serious issue,
modern medicine has developed
treatments for Rh incompatibility
that protect both the mother and
the baby.
HIV ½ Non-reactive Non-reactive A negative/non-reactive HIV test
result means that HIV antibodies
or antigens weren’t detected in
the test sample. If a person has
had no potential exposure to HIV
within the test’s window period,
they are considered negative for
HIV infection. If a person has
had potential exposure within the
test’s window period, HIV testing
must be repeated after they are
past the window period.
Syphilis Non-reactive Non-reactive A negative or nonreactive result
means that a person has no
current or past infection with
syphilis. Normal value ranges
may vary slightly among
different laboratories. Some labs
use different measurements or
test different samples.
HBsAg Non-reactive Non-reactive Normal results are negative or
(Qualitative) nonreactive, meaning that no
hepatitis B surface antigen was
found.
CBC WBC: 11.24 4.40-11.00 The normal number of WBCs in
the blood is 4,500 to 11,000
WBCs per microliter (4.5 to 11.0
× 109/L). Normal value ranges
may vary slightly among
different labs. Some labs use
different measurements or may
Neutrophils: 37.00-80.00 test different specimens.
81.30 H The normal range for a
neutrophil (band + seg) count is
1160 – 8300/µL for blacks and
1700 – 8100/µL for other
groups. This is 45%-74% segs
and 0% - 4% bands. Obesity and
cigarette smoking are associated
an increased neutrophil count. It
is estimated that for each pack
per day of cigarettes smoked,
the granulocyte count may be
Lymphocytes: 10.0-50.0 expected to rise by 1000/µL.
11.80
 The normal range of the
lymphocyte count is 1000 –
4800/µL or 16% - 45%.
0.00-12.00 The normal range for the
Monocytes: monocyte count is 200 – 950/µL
6.10 or 4% - 10%.
0.00-7.00 The normal range of the absolute
Eosinophils: eosinophil count is 0 – 450/µL or
0.50 0% - 7%.
0.00-2.50 The most aesthetically pleasing
Basophils: 0.30 of all the leukocytes, the
basophils are also the least
numerous, the normal range of
their count in peripheral blood
being 0 – 200/µL or 0% - 2%.
4.50-5.10 A typical lab’s normal range for
RBC Count: RBC count is 4.2 – 5.4 x 106/µL
3.62 for females; for adults males it is
4.7 – 6.1 x 106/µL.
12.30-15.30 The normal range for Hgb is
Hemoglobin: highly age and sex dependent,
11.50 with men having higher values
than women. Adults have higher
values than children, except
neonates, which have the highest
values of all. For a typical clinical
lab, the young adult female
normal range is 12-16 g/dL; for
adult males it is 14 – 18 g/dL.
35.90-44.60 The normal range of Hematocrit
Hematocrit: (Hct) is 0.37 – 0.47 L/L for
34.00 females, and 0.42 – 0.52 L/L for
males.
150.00-400.00 The normal platelet range count
Platelet Count: is 133 – 333 x 103/µL.
132.00 80.00-96.00 The normal range of the Mean
MCV: 93.90 corpuscular volume (MCV) is 8 -
94 fL.
27.50-33.20 Since small cells have less Hgb
MCH: 31.70 than large cells, variation in the
MCH tends to track along with
that of the MCV. The MCH is
something of a minor leaguer
among the indices in that it adds
little information independent of
the MCV. This value is helpful in
pinpointing the source of an
anemia.
32.00-36.00 The normal range of Mean
MCHC: 33.80 corpuscular Hgb concentration
(MCHC) is 32 – 36 g/dL.
11.60-14.80 The normal range for RDW is
RDW-CV: 14.30 11.5% - 14.5%.
 6.00-11.00 The normal value for mean
MPV: 10.00 platelet volume is 25
micrometers in diameter.
11.00-22.00 Platelet distribution width (PDW)
PDW: 17.30 is a regular parameter in blood
routine examination which
reflects variation of platelet size
distribution with a range from
8.3% to 56.6%. There is always
a morphological change when
platelet is activated in the
environment of inflammation.
0.15-0.40 The normal range for PCT is
PCT: 0.13 0.15-0.40 and the patient’s PCT
is below normal.
44.00-140.00 P-LCC signifies platelets larger
P-LCC: 41.00 than 12 fl and smaller than 30fl.
Its normal range is within 44.00-
140.00. Patient is below normal.
18.00-50.00 Platelet-large cell ratio (P-LCR) is
P-LCR: 31.40 defined as the percentage of
platelets that exceed the normal
value of platelet volume of 12 fL
in the total platelet count. The
patient’s P-CLR is within normal
range.
Urinalysis Macroscopic
Examination
Color: Yellow Color: Straw Normal urine color is a light
yellow to a dark amber color.
Volume: 30ml Volume: 800 The normal range for 24-hour
to 2000 urine volume is 800 to 2,000
ml/24hr. milliliters per day (with a normal
fluid intake of about 2 liters per
day).
Transparency: Clarity: Clear / Normal urine can be clear or
Hazy Cloudy cloudy. Substances that cause
cloudiness but that are not
considered unhealthy include
mucus, sperm and prostatic fluid,
cells from the skin, normal urine
crystals, and contaminants such
as body lotions and powders.
Other substances that can make
urine cloudy, like red blood cells,
white blood cells, or bacteria,
indicate a condition that requires
attention.
Specific Specific Specific Gravity will increase with
Gravity: 1.010 Gravity: 1.003 the amount of dissolved particles
– 1.030 (concentrated) in it. Specific
gravity will decrease when the
water content is high and the
 dissolved particles are low (less
concentrated). Low specific
gravity (<1.005) is characteristic
of diabetes insipidus,
nephrogenic diabetes insipidus,
acute tubular necrosis, or
pyelonephritis.
Protein: Only a very small amount of
Chemical Negative protein should be excreted into
Examination the urine in a 24-hour period
Albumin: Trace (normal is 0-trace). Albumin is
usually the first protein to be
excreted in disease conditions.
pH: 4.5 - 7.2 Urine is normally slightly acid
pH: 6.5 (4.5 - 7.2 normal range). If
alkaline, it can be indicative of
infection.
Ketone: Ketones (acetone, aceotacetic
Ketone: 2+ Negative acid, beta-hydroxybutyric acid)
resulting from either diabetic
ketosis or some other form of
calorie deprivation (starvation),
are easily detected using either
dipsticks or test tablets
containing sodium nitroprusside.
Blood: Blood in your urine requires
Blood: 1+ Negative additional testing — it may be a
sign of kidney damage, infection,
kidney or bladder stones, kidney
or bladder cancer, or blood
disorders.
Glucose: Less than 0.1% of glucose
Glucose: Negative normally filtered by the
NEGATIVE glomerulus appears in urine (<
130 mg/24 hr).
Nitrite: Normal urine contains chemicals
Nitrite: Negative called nitrates. If bacteria enter
NEGATIVE the urinary tract, nitrates can
turn into different, similarly
named chemicals called nitrites.
Nitrites in urine may be a sign of
a urinary tract infection (UTI).
Bilirubin: Bilirubin is seen in urine when
Bilirubin: Negative there is obstructive jaundice and
NEGATIVE will color casts as deep yellow
brown.
Urobilinogen: Normal urine contains some
Urobilinogen: trace to 1 urobilinogen. If there is little or
NORMAL mg/dL no urobilinogen in urine, it can
mean your liver isn't working
correctly. Too much urobilinogen
in urine can indicate a liver
 Microscopic disease such as hepatitis or
Examination WBC: 0-5/HPF cirrhosis.
WBC: 1-4/HPF Normally 0-5 WBCs/HPF may be
seen in urine of normal males
with slightly higher ranges in
females. Increased numbers
may indicate renal disease or
RBC: 0.2/HPF acute infection.
RBC: 1-3/HPF Normally 0-2 RBCs/HPF may be
seen in urine from males and
non-menstruating females.
Increased numbers may indicate
Epithelial Cell: renal hematuria.
Epithelial Cells: Few A few epithelial cells are normal
Few and indicate normal sloughing
off of aging cells. Increased
numbers may indicate renal
disease, urinary tract infection,
or poor technique in specimen
Mucus collection.
Mucus Threads: Threads: Few Light mucus is normally found in
Rare urine and can sometimes be
Bacteria: Few confused with hyaline casts.
Bacteria: A few bacteria are normally seen
Moderate due to poor technique in
collection of the specimen.
Increased numbers may indicate
Crystals: kidney, bladder, or urinary tract
Crystals (Acidic Urine) infection.
Amorphous Amorphous Normal crystals found in acidic
Urates: Urates urine are amorphous urates, uric
Moderate Uric Acid acid, and calcium oxalate. while
Calcium in alkaline urine, amorphous
Oxalate phosphates, triple phosphates,
(Alkaline ammonium biurates, calcium
Urine) phosphates and calcium
Amorphous carbonates are seen.

Diagnostic Tests

Date Type of Patient’s result Significance/ interpretation

test
6/17/20 Ultrasound Biometry:
I. No. of fetuses: 1 This is done to confirm the number
of babies.
II. BPD: 8.72 cm The normal biparietal diameter
measurement increases from
roughly 2.4 centimeters at 13
weeks to approximately 9.5
centimeters when a fetus is at term.
BPD is at 35 weeks and 1 day.
III. HC: 31.3 cm The head circumference (HC)
measurement may be used to
 estimate gestational age in a similar
manner to BPD measurement. Head
circumference is at 35 weeks and 1
day.
IV. AC: 29.9 cm Measurement of the fetal abdominal
circumference (AC) is obtained in
the transaxial view of the fetal
abdomen. The AC is measured at
the level of the fetal liver, using the
umbilical portion of the left portal
vein as a landmark (Fig. 4). The
fetal stomach is at the same level,
which is slightly caudad to the fetal
heart and cephalad to the kidneys.
The AC measurement is taken from
the outermost aspects of the fetal
soft tissues. Measurement of the AC
is performed in the same manner as
that of the HC, that is, by (1)
tracing the outer perimeter of the
AC by the trackball on the
ultrasonic equipment or by digitizer
or (2) the same equation as for HC
using transverse and
anteroposterior diameters of the
fetal abdomen. AC is at 33 weeks
V. FL: 6.85 cm and 6 days.
Femur Length (FL) is measured
along the long axis of the bone; a
straight measurement of the
osseous portion is taken from one
end to the other, disregarding bone
curvature. The femoral neck and
both proximal and distal epiphyseal
cartilages are excluded from the
measurement. Femur length (FL)
measurements may be used to
accurately predict gestational age
between 14 weeks' gestation and
term. FL is normal as it is in the
VI. Average ultrasonic age: 35th week and 1 day.
34W6D Gestational age is the common term
used during pregnancy to describe
how far along the pregnancy is. It is
measured in weeks, from the first
day of the woman's last menstrual
cycle to the current date. A normal
pregnancy can range from 38 to 42
weeks. Average ultrasonic age is at
VII. Estimated Fetal Weight: 34 weeks and 6 days, thus is
2450 grams normal. Assessment of fetal weight
is a vital and universal part of
antenatal care, not only in the
management of labor
and delivery but often during the
 management of high-risk
pregnancies and growth monitoring.
Birth weight of an infant is the
single most important determinant
of newborn survival. Both low and
excessive fetal weights at delivery
are associated with an increased
risk of newborn complications
during labor and puerperium.
Estimated fetal weight is normal.
VIII: Ultrasonic EDC: The accurate determination of a
06/18/2020 patient's "due" date, referred to by
doctors and midwives as the EDC
(Estimated Date of Confinement) or
EDD (Estimated Date of Delivery),
is very important for a variety of
reasons. The timing of certain tests,
the monitoring of the baby's
growth, and the correct diagnosis of
premature labor, or being truly
"overdue," (postdates), as well as
many other situations that arise in
the course of a typical pregnancy,
all depend on a correct
determination of the EDC for
appropriate management.
Ultrasonic EDC is accurate.
Placenta: posterior, high flying Posterior high flying is normal. The
upper (or fundal) portion of the
uterine back wall is one of the best
locations for the fetus to be in. It
allows them to move into the
anterior position just before birth.
Furthermore, a posterior placenta
does not affect or interfere with the
growth and development of the
fetus.
Grade: 2 Placenta praevia is graded into 4
categories from minor to major. If a
woman is grade 1 or 2, it may still
be possible to have a vaginal birth,
but grades 3 or 4 will require a
caesarean section.
Presentation: Cephalic Cephalic presentation is when the
fetal head is down and facing the
woman’s back. Almost 95 percent of
babies in the head-first position
face this way. This position is
considered to be the best for
delivery because its easiest for the
head to “crown” or come out
smoothly as the woman gives birth.
FHB: 152 bpm
 A normal fetal heart rate (FHR)
usually ranges from 120 to 160
beats per minute (bpm) in the in-
utero period. It is measurable
sonographically from around 6
weeks and the normal range varies
during gestation, increasing to
around 170 bpm at 10 weeks and
decreasing from then to around 130
Amniotic Fluid Index: 10.3 cm bpm at term.
A normal amniotic fluid index is 5
cm to 25 cm using the standard
assessment method. Less than 5
cm is considered oligohydramnios,
and
greater than 25 cm is considered
polyhydramnios.
Ultrasound Biometry:
I. No. of fetuses: 1 This is done to confirm the number
of babies.
II. BPD: 4.34 cm The normal biparietal diameter
measurement increases from
roughly 2.4 centimeters at 13
weeks to approximately 9.5
centimeters when a fetus is at term.
BPD is at 19 weeks and 1 day.
III. HC: 16.3 cm The head circumference (HC)
measurement may be used to
estimate gestational age in a similar
manner to BPD measurement. Head
circumference is at 19 weeks.
IV. AC: 13.0 cm Measurement of the fetal abdominal
circumference (AC) is obtained in
the transaxial view of the fetal
abdomen. The AC is measured at
the level of the fetal liver, using the
umbilical portion of the left portal
vein as a landmark (Fig. 4). The
fetal stomach is at the same level,
which is slightly caudad to the fetal
heart and cephalad to the kidneys.
The AC measurement is taken from
the outermost aspects of the fetal
soft tissues. Measurement of the AC
is performed in the same manner as
that of the HC, that is, by (1)
tracing the outer perimeter of the
AC by the trackball on the
ultrasonic equipment or by digitizer
or (2) the same equation as for HC
using transverse and
anteroposterior diameters of the
fetal abdomen. AC is at 18 weeks
V. FL: 3.13 cm and 4 days.
 Femur Length (FL) is measured
along the long axis of the bone; a
straight measurement of the
osseous portion is taken from one
end to the other, disregarding bone
curvature. The femoral neck and
both proximal and distal epiphyseal
cartilages are excluded from the
measurement. Femur length (FL)
measurements may be used to
accurately predict gestational age
between 14 weeks' gestation and
term. FL is normal as it is in the
VI. Average ultrasonic age: 19th week and 5 days.
19W0D Gestational age is the common
term used during pregnancy to
describe how far along the
pregnancy is. It is measured in
weeks, from the first day of the
woman's last menstrual cycle to the
current date. A normal pregnancy
can range from 38 to 42 weeks.
VII. Estimated Fetal Weight: Average ultrasonic age is at 19
275 grams weeks, thus is normal.
Assessment of fetal weight is a vital
and universal part of antenatal
care, not only in the management
of labor and delivery but often
during the management of high-risk
pregnancies and growth monitoring.
Birth weight of an infant is the
single most important determinant
of newborn survival. Both low and
excessive fetal weights at delivery
are associated with an increased
risk of newborn complications
VIII: Ultrasonic EDC: during labor and puerperium.
06/20/2020 Estimated fetal weight is normal.
The accurate determination of a
patient's "due" date, referred to by
doctors and midwives as the EDC
(Estimated Date of Confinement) or
EDD (Estimated Date of Delivery),
is very important for a variety of
reasons. The timing of certain tests,
the monitoring of the baby's
growth, and the correct diagnosis of
premature labor, or being truly
"overdue," (postdates), as well as
many other situations that arise in
the course of a typical pregnancy,
all depend on a correct
determination of the EDC for
appropriate
 Placenta: posterior, high flying
Grade: 2
Presentation: Cephalic
FHB: 141 bpm
Amniotic Fluid Index: 4 cm
Ultrasound General Survey:
No. of fetuses: Singleton
Presentation: Cephalic
management. Ultrasonic EDC is
accurate.
Posterior high flying is normal. The
upper (or fundal) portion of the
uterine back wall is one of the best
locations for the fetus to be in. It
allows them to move into the
anterior position just before birth.
Furthermore, a posterior placenta
does not affect or interfere with the
growth and development of the
fetus.
Placenta praevia is graded into 4
categories from minor to major. If a
woman is grade 1 or 2, it may still
be possible to have a vaginal birth,
but grades 3 or 4 will require a
caesarean section.
Cephalic presentation is when the
fetal head is down and facing the
woman’s back. Almost 95 percent of
babies in the head-first position
face this way. This position is
considered to be the best for
delivery because its easiest for the
head to “crown” or come out
smoothly as the woman gives birth.
A normal fetal heart rate (FHR)
usually ranges from 120 to 160
beats per minute (bpm) in the in-
utero period. It is measurable
sonographically from around 6
weeks and the normal range varies
during gestation, increasing to
around 170 bpm at 10 weeks and
decreasing from then to around 130
bpm at term.
A normal amniotic fluid index is 5
cm to 25 cm using the standard
assessment method. Less than 5
cm is considered oligohydramnios,
and greater than 25 cm is
considered
polyhydramnios.
This is done to confirm the number
of babies.
Cephalic presentation is when the
fetal head is down and facing the
woman’s back. Almost 95 percent of
babies in the head-first position
face this way. This position is
considered to be the best for
delivery because
its easiest for the head to “crown” or
 come out smoothly as the woman
gives birth.
FHB: 148 beats/min A normal fetal heart rate (FHR)
usually ranges from 120 to 160
beats per minute (bpm) in the in-
utero period. It is measurable
sonographically from around 6
weeks and the normal range varies
during gestation, increasing to
around 170 bpm at 10 weeks and
decreasing from then to around 130
bpm at term.
AFI: 13.1 cm A normal amniotic fluid index is 5
cm to 25 cm using the standard
assessment method. Less than 5
cm is considered oligohydramnios,
and greater than 25 cm is
considered polyhydramnios.
Deepest vertical pocket: 4.4 cm A 2-8 cm deepest vertical pocket is
normal but should be taken in the
context of subjective volume.
Biometry: The normal biparietal diameter
BPD: 6.0 cm measurement increases from
roughly 2.4 centimeters at 13
weeks to approximately 9.5
centimeters when a fetus is at term.
BPD is at 24 weeks and 3 days.
HC: 22.4 cm The head circumference (HC)
measurement may be used to
estimate gestational age in a similar
manner to BPD measurement. Head
circumference is at 24 weeks and 3
AC: 17.0 cm days.
Measurement of the fetal abdominal
circumference (AC) is obtained in
the transaxial view of the fetal
abdomen. The AC is measured at
the level of the fetal liver, using the
umbilical portion of the left portal
vein as a landmark (Fig. 4). The
fetal stomach is at the same level,
which is slightly caudad to the fetal
heart and cephalad to the kidneys.
The AC measurement is taken from
the outermost aspects of the fetal
soft tissues. Measurement of the AC
is performed in the same manner as
that of the HC, that is, by (1)
tracing the outer perimeter of the
AC by the trackball on the
ultrasonic equipment or by digitizer
or (2) the same equation as for
HC using
transverse and anteroposterior
 diameters of the fetal abdomen. AC
FL: 4.1 cm is at 21 weeks and 6 days.
Femur Length (FL) is measured
along the long axis of the bone; a
straight measurement of the
osseous portion is taken from one
end to the other, disregarding bone
curvature. The femoral neck and
both proximal and distal epiphyseal
cartilages are excluded from the
measurement. Femur length (FL)
measurements may be used to
accurately predict gestational age
between 14 weeks' gestation and
term. FL is normal as it is in the
Average ultrasonic age: 23W6D 23rd week and 6 days.
Gestational age is the common term
used during pregnancy to describe
how far along the pregnancy is. It is
measured in weeks, from the first
day of the woman's last menstrual
cycle to the current date. A normal
pregnancy can range from 38 to 42
weeks. Average ultrasonic age is at
EDC: June 21, 2020 23 weeks and 6 days, thus is
normal. The accurate determination
of a patient's "due" date, referred to
by doctors and midwives as the EDC
(Estimated Date of Confinement) or
EDD (Estimated Date of Delivery),
is very important for a variety of
reasons. The timing of certain tests,
the monitoring of the baby's
growth, and the correct diagnosis of
premature labor, or being truly
"overdue," (postdates), as well as
many other situations that arise in
the course of a typical pregnancy,
all depend on a correct
determination of the EDC for
appropriate management.
EFW (Hadlock-4parameter): 550 Ultrasonic EDC is accurate.
grams Assessment of fetal weight is a vital
and universal part of antenatal
care, not only in the management
of labor and delivery but often
during the management of high-risk
pregnancies and growth monitoring.
Birth weight of an infant is the
single most important determinant
of newborn survival. Both low
and
excessive fetal weights at delivery
are associated with an increased
risk

Non-biometric Parameters:
Placenta:
Location: Anterior
Grade: 1
Distance to int. os: high flying
Detailed Scan:
AV: 0.6 cm
PV: 0.5 cm
Hemisphere: 3.1 cm
Lat. Ventrile (AV width): 0.5 cm
Transverse cerebellar dia.: 2.9
cm 25 weeks
Cisterna Magna: 0.7 cm
Nuchal Fold: 0.4 cm
of newborn complications during
labor and puerperium. Estimated
fetal weight is normal.
An anterior placenta is when the
placenta attaches to the front wall
of the uterus. This is a normal place
for the placenta to implant and
develop, but there are a few things
to be aware of if you have one.
Placenta praevia is graded into 4
categories from minor to major. If a
woman is grade 1 or 2, it may still
be possible to have a vaginal birth,
but grades 3 or 4 will require a
caesarean section.
An anterior placenta simply means
your placenta is attached to the
front wall of your uterus, between
the baby and your tummy. It's a
completely normal place for it to
implant and develop. It isn't
connected to having a low-lying
placenta (called placenta previa)
and it shouldn't cause you
problems.
AV and PV are within normal ranges
which means no abnormalities are
present.
Hemisphere is normal and requires
no further assessment.
The average normal width for the
atrium of the fetal lateral ventricle
is approximately 0.76 cm, and most
studies find that while brain size
increases, ventricle width is stable
during the second and third
trimesters (9–13).
In obstetric imaging, the fetal
transverse cerebellar diameter
(TCD) is often measured as an
additional fetal biometric
parameter. It is measured as the
maximal diameter between the
cerebellar hemispheres on an axial
scan. TCD is within normal range.
Cisterna magna normally measures
between 2-10 mm in the second
and third trimesters.
The nuchal fold is a normal fold of
skin at the back of a baby's neck.
This can be measured between 15 to

Nasal Bone: 0.8 cm
Right Orbit: 1.3 cm
Left Orbit: 1.3 cm
Interobitdia: 1.4 cm
Biorbldia: 4.1 cm
Right and left ocular lens: Seen
Nose and Lips: Intact
Hard Palate: Intact
Four chamber view: Normal /
Axis: 45
Cardiothoracic ratio: 7.9 / 15.7:
50.7%
22 weeks in pregnancy as part of a
routine prenatal ultrasound. Follow-
up is offered when the nuchal fold is
thick (6 mm or more). Many
healthy babies have thick nuchal
folds.
The median nasal bone lengths
were 1.4 mm (range, 1.1-1.9), 1.7
mm
(range, 1.1-2.5), and 2.1 mm
(range, 1.5-2.6) at gestational age
of 11, 12, and 13 weeks
respectively. The median crown-
rump length was 57.1 mm (range,
40.7- 75.9), and the median nuchal
translucency thickness was 1.2 mm
(range, 0.7-3.0).
On ultrasound, the orbits appear as
echolucent circles in the face of the
fetus, and inside these structures
the lens can be easily identified.
Left and right orbits are normal.
Interobitdia and Biorbldia are within
normal range, thus require no
further complications and
assessment.
Normally, babies are born with a
transparent lens in each eye. The
lens focuses objects on the retina,
and it brings objects into focus,
making it possible for the eye to
see, Instead of a transparent lens,
some babies are born with a milky
white lens, which is too cloudy to
focus on objects.
When the nose, lips and hard palate
are intact, it indicates a normal
finding.
The heart has four chambers: two
atria and two ventricles. The right
atrium receives oxygen-poor blood
from the body and pumps it to the
right ventricle. The right ventricle
pumps the oxygen-poor blood to
the lungs. The left atrium receives
oxygen-rich blood from the lungs
and pumps it to the left ventricle. It
is within normal finding.
The cardiothoracic ratio is measured
on a PA chest x-ray, and is the ratio
of maximal horizontal cardiac
diameter to maximal horizontal
thoracic diameter (inner edge of
ribs/edge of pleura). A normal
measurement is 0.42-0.50. A
 measurement <0.42 is usually
deemed to be pathologic.
The right ventricular outflow tract
Right outflow tract: Intact (RVOT) refers to the region of blood
outflow from the right ventricle
between the supraventricular crest
and the pulmonary valve. It is
comprised of the conus arteriosus
(infundibulum), ventricular septum
and right ventricular free wall. It is
intact, thus indicating that it is
normal.
The left ventricular outflow tract
(LVOT) is considered represent the
Left outflow tract: Intact region of the left ventricle that lies
between the anterior cusp of the
mitral valve and the ventricular
septum. Its dimensions are often
recorded in TAVI work up studies.
Left outflow tract is normal.
Most babies' umbilical cords have
three blood vessels: one vein,
3 vessel cord Cord (2ar/1v): which brings nutrients from the
Seen placenta to baby, and two arteries
that bring waste back to the
placenta. But a two-vessel cord has
just one vein and one artery —
that's why the condition is also
referred to as having a single
umbilical artery. It is seen, hence is
a normal finding.
The spine has three normal curves:
Spine (Cervical, Thoracic, cervical, thoracic, and lumbar, and
Lumbar): Seen is seen, therefore it is normal.
There are seven cervical vertebrae
in the neck, 12 thoracic vertebrae in
the torso and five lumbar vertebrae
in the lower back.
Based on the children's ages normal
Right Kidney: 2.5 x 1.4 x 1.5 cm average renal length on ultrasound
Left kidney: 2.5 x 1.4 x 1.5 cm are as follows: 0 to 2 months: 5 cm
(approximately 2 inches) 2 months
to 6 months: 5.7 cm. 6 months to 1
year: 6.2 cm (2.5 inches)
Bladder ultrasound can give
information about the bladder wall,
Bladder: Seen diverticula (pouches) of the bladder,
bladder stones, and large tumors in
the bladder. Kidney ultrasound can
show if the kidneys are in the right
place or if they have blockages,
kidney stones, or tumors. It is
within normal range as it is seen.
 First trimester sonographic prenatal
Sex: Female sex determination can be done from
11 weeks gestation using the
direction of the genital tubercle and
the “sagittal sign.” The downward
direction of the tubercle is
considered a female while the
upward direction a male.

The results signifies that all is good

Extremities: (Right) and within normal range. In
Humerus: 3.8cm addition, no gross congenital
Radius:3.2 cm anomaly was seen at the time of
Ulna:3.6 cm the scan, thus indicating that there
Fingers: Complete is no need for further assessment
Femur: 3.9 cm and complication.
Tibia: 3.8 cm
Fibula: 3.4 cm
Foot length: 4
Toes: Complete

Problem List

Number Focus / Nursing Diagnosis

of
Priority
1 Acute pain related to collection of blood between uterine wall and placenta as
evidenced by muscle tension.
2 Risk for trauma related to loss of large muscle coordination.
3 Risk for fetal injury related to problems of maternal well-being that directly affect
the developing fetus.

Drug Study
 Drug Classificati Mechani Indication Contraindic Adverse Nursing
name on sm of ation reaction responsibilitie
action s

Generic Anticonvul Levetiracetam Levetiracetam is a Contraindicate Dizzi Before:

name: is an novel antiepileptic d to 1. Administer the 10
sants drug used in the ness. rights to medication
Levetiraceta antiepileptic hypersensitivit
m drug marketed treatment y reaction to
Head administration. 2.
of partial seizures, ache. Explain information
since 2000. Its myoclonic
LEV or any about the medication
Brand name: novel seizures, and component of Irrita to the patient.
- Keppra mechanism of tonic-clonic the bility. 3.Answer questions
- Keppra XR action seizures. In 2000, formulation. Loss regarding the
– Spritam is modulation the FDA approved medication. 4.
of synaptic the use of the oral of strength Assess for allergies,
Actual neurotransmitt formulation as and energy. types of reactions
er release adjunctive therapy Mood and any
dosage, for the treatment contraindicat ions
Route, through
of focal seizures, and present.
frequency: binding to the myoclonic behavior
500 mg /tab synaptic seizures, and
vesicle protein
changes. During 1. Assist the
1 tab BID primary patient in taking the
SV2A in the generalized Slee
medication correctly.
brain. seizures. piness. After: 1. Ensure that
the patient has taken
the medication. 2.
Dispose used
materials properly. 3.
Assess the patient
for any adverse
reactions after taking
the medication and
notify the physician.

An exogenous Folic acid is Contraindicate Before:

Generic Vitamins, source of usually indicated d to patients 1. Administer the 10
name: Water- folate is in the treatment with rights to medication
Folic Acid required for of megaloblastic hypersensitivit administration. 2.
Soluble
nucleoprotein anemias of y to folic acid Explain information
synthesis and pregnancy. Folic or its about the medication
Brand formulation is a to the patient.
the acid Bronchospas
name: maintenance requirements potential m
3.Answer questions
regarding the
Folvite of normal are markedly contraindicatio
Erythema medication. 4.
Actual erythropoiesis. increased during n to its Assess for allergies,
administration. Malaise
dosage, Folic acid, pregnancy, and types of reactions
whether given deficiency will One must Pruritus and any
Route, Rash Slight
by mouth or result in fetal recall that contraindications
frequency research has flushing present.
parenterally, sti damage (see
: 1 tab OD mulates the INDICATIONS). yet to establish
production of hypersensitivit During 1. Assist the
red blood cells, y reactions to patient in taking the
white blood folic acid, but a medication correctly.
cells, and history of an
anaphylactic After: 1. Ensure that
platelets in the patient has taken
persons reaction from the medication. 2.
suffering from any substance Dispose used
certain must deter the materials properly. 3.
megaloblastic administration Assess the patient
anemias. of the for any adverse
offending reactions after taking
agent. the medication and
notify the physician.

Generic Cefuroxime is Contraindic

Cefuroxime is a ated ated to
name: Cephalosp a bactericidal cephalosporin Before:
orin agent that acts patients with 1. Administer the 10
Cefuroxim indicated for the hypersensit
antibiotics by inhibition of treatment of a
rights to medication
e bacterial cell ivity to administration. 2.
variety of cephalospo Explain information
wall synthesis. infections
Brand Cefuroxime rins and about the medication
including acute severe to the patient.
name: has activity in relatedanti stomach pain,
Nursing Care Plan

Defining Nursing Scientific Goal of Intervention Rationale

Characteristics Diagnosis Analysis Care
S: Acute pain Abruptio After 8 Independen To help determine
related to placentae, also hours of t: Assess the possibility of
O: collection of known as nursing for referred underlying
-Abdominal blood placental interventi pain as condition or organ
guarding between abruption, occurs on appropriate dysfunction
-Muscle tension uterine wall when the , the . requiring
-Irritability and placenta placenta partially patient treatment.
-V/S are as as evidenced or entirely will Individuals with
follows: BP: by muscle separates from exhibit external locus of
130/80 tension. the uterus, the control may take
Temperature: posing a danger following: little or no
37.1 of hemorrhage. - Patient responsibili ty for
Pulse Rate: 92 This is most will report pain manageme
RR: 24 common between relief or Note client’s nt.
O2 Saturation: 24-26 weeks of control of locus To rule out
98% pregnancy and is pain. of control. worsening of
considered a - Patient underlying
significant issue. will follow condition or
In mild prescribed developme nt of
circumstances, pharmacolo complicatio ns.
the patient may gic al Pain is a
be restricted to regimen. subjective
limited activity or - Patient experience and
bed rest for the will cannot be felt by
duration of the verbalize others.
pregnancy, but in nonpharma Note and
more severe col ogical investigate These are usually
cases, if there is methods changes altered in acute
maternal or fetal that from pain. To medicate
impairment, provide previous as appropriate
delivery is relief. reports of .
indicated. While - Patient pain.
most cases of will
placental demonstr
abruption occur ate use of
suddenly, relaxation
persistent skills and Acknowledge
abruption can diversion the client’s To promote
occur when there al description of nonpharma
is a tiny activities pain and cological pain
separation that as convey manageme nt.
causes indicated. acceptance of To enhance
continuous client’s placental
bleeding beneath response to perfusion.
the placenta. pain.

To prevent
Source: Monitor skin fatigue.
Anonymous. color and
(n.d.). Nursing temperature To maintain an
Care Plan for and vital signs. acceptable level
Abruptio of pain.
Placentae / Note when
Placental pain To confirm
abruption. occurs. diagnosis.
Nursing.com.
Retrieved from: Provide
https://nursing.c comfort
om/lesson/nursin measures,
g-care-plan-for- quiet
abruptio- environment,
placentae- and calm
placental- activities.
abruption/

Position
mother in the
left lateral
position with
the head of
the bed
elevated.
Encourag
e
adequate
rest
periods.
Dependent
:
Administer
medicatio
n, as
prescribed
.

Collaborativ
e: Assist in
laboratory
and
diagnostic
study
findings.

Source: Sutton, S.
M., Thompson, B. R.,
& Wittman- Price, R.
(2013).
Nursing Concept
Care Maps for Safe
Patient Care.
1st edition. F.A.
Davis Company.
Bibliography

Anonymous. (n.d.). Nursing Care Plan for Abruptio Placentae / Placental abruption. Nursing.com.
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placental-abruption/

Stafstrom, C. E. (1998). Back to Basics: The Pathophysiology of Epileptic Seizures: A Primer for
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Anonymous. (n.d.). Epilepsy. Mayo Clinic. Retrieved from:

https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-
20350093

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Anonymous. (2019). FTA-ABS blood test. UCSF Health. Retrieved from:

https://www.ucsfhealth.org/medical-tests/fta-abs-blood-test

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