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Cavite recognized for
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CAVITE STATE UNIVERSITY
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Indang, Cavite
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College of Nursing

Retained Placenta

Presented by:

II - A / SECTION 1 / GROUP # 4

ALVAREZ, CELINE KYLE M.

CALIPAY, JADE FLORIDEL L.
FODRA, MYKA J.
LAGUD, MILYN F.
PANGILINAN, RONA MAE P.

Presented to:

Ms. Ariane Joy S. Cantilero, RM, RMT

Ms. Varhielyn M. Escalante, RM, BSM
Ms. Maria Khristina C. Huerto, RM, BSM
Ms. Joymie F. Matreo, RM, LPT
Ms. Kcllyn Joy O. Separa, RM, BSM©
Ms. Maria Judith Tugado, RM, BSM©
Clinical Instructors

Date:

FEBRUARY 2023

In Partial Fulfillment of the Requirement in MDWY 90 for the Diploma in Midwifery

I
 ACKNOWLEDGEMENT

This case study would not have been possible without the participation and

collaboration of numerous people, some of whose names may or may not have been

made public. We sincerely recognize and value the efforts they made. We would like

to express our gratitude of the following:

To all of our Clinical Instructors, Ms. Ariane Joy S. Cantilero, RM, RMT, Ms.

Varhielyn M. Escalante, RM, BSM, Ms. Maria Khristina C. Huerto, RM, BSM, Ms.

Joymie F. Matreo, RM, LPT, Ms. Kcllyn Joy O. Separa, RM, BSM©, Ms. Maria Judith

Tugado, RM, BSM© for the patience, effort and time extended checking the draft,

sharing suggestions and constructive criticisms which meant so much for the

completion of this study.

To our Family and Friends, thank you for your unconditional love, support,

and patience. For continuously understanding and believing in us. Your constant

support serves as our inspiration and motivation to finish this study.

To Client FSM, who is the participant of this study. For being cooperative and

approachable throughout the study, for taking the time to answer all of the questions

with honesty.

Above all, Thanks to the Great Almighty. The provider of all wisdom and

understanding for his unending love, Thank you.

II
 TABLE OF CONTENTS

INTRODUCTION....................................................................................................................5
I. DEMOGRAPHIC DATA................................................................................................6
II. REASON FOR SEEKING HEALTH CARE................................................................7
III. HISTORY OF PRESENT ILLNESS.........................................................................7
IV. PAST MEDICAL HISTORY......................................................................................8
V. OBSTETRIC – GYNECOLOGICAL HISTORY.........................................................8
VI. HEREDO – FAMILIAL HISTORY............................................................................9
A. GENOGRAM 9
B. FAMILY APGAR 10
VII. DEVELOPMENTAL HISTORY..............................................................................11
VIII. GORDON’S 11 FUNCTIONAL HEALTH PATTERN..........................................12
A. HEALTH PERCEPTION – HEALTH MANAGEMENT 12
B. NUTRITIONAL – METABOLIC 13
C. ELIMINATION 14
D. ACTIVITY – EXERCISE 14
E. SLEEP – REST 16
F. COGNITIVE – PERCEPTUAL 17
G. SELF PERCEPTION – SELF CONCEPT 17
H. ROLE – RELATIONSHIP 18
I. SEXUALITY – REPRODUCTIVE 19
J. COPING – STRESS 19
K. VALUE – BELIEF 19
IX. COMPREHENSIVE PHYSICAL EXAMINATION................................................19
A. Vital Signs 19
B. Anthropometric Data 20
C. General Appearance 20
D. Focused Assessment 21
X. DIAGNOSTIC TEST....................................................................................................22
A. Non – Invasive 22
B. Invasive 22
XI. PATHOPHYSIOLOGY............................................................................................24
A. ANATOMY 26
B. CLIENT - BASED 27
XII. CASE MANAGEMENT...........................................................................................28
A. Drug Study 28

III
XIII. NURSING MANAGEMENT....................................................................................29
A. Listing of Nursing Problems...............................................................................29
I. Severe Bleeding due to Retained Fragments..........................................................29
II. Low Hemoglobin...........................................................................................................29
III. Multiparity..................................................................................................................29
B. Prioritization of Nursing Problems....................................................................29
XIV. PLANS FOR NURSING ACTION..........................................................................32
XV. DISCHARGE PLAN.................................................................................................35
XVI. RECOMMENDATION.............................................................................................37
PAMPHLET (ENGLISH)......................................................................................................38
PAMPHLET (TAGALOG) 39

IV
INTRODUCTION

Retained placenta after vaginal delivery is a relatively common cause of

obstetrical morbidity. It usually occurs in around 1–3% of deliveries, this is typically

diagnosed when the placenta fails to spontaneously separate during the third stage

of labor when a patient experiences excessive bleeding in absence of placental

separation or if there is remaining placental tissue after the placenta is delivered.

Placentas that fail to spontaneously separate can be a cause of significant surgical

and hemorrhagic morbidity. If left untreated, retained placenta is considered the

second leading cause of postpartum hemorrhage (PPH).

Retained placenta after vaginal delivery is diagnosed when a placenta does

not spontaneously deliver within a designated amount of time, variably defined as a

period of 18–60 mins. It may also be confirmed when a patient experiences

significant amount of bleeding after the delivery of the placenta. Normal placenta

delivery requires adequate uterine contractions, with shearing of the placenta and

decidua from the uterine wall and expulsion of the tissue. 

Risk factors for retained placenta parallel those for uterine atony and PAS

and include prolonged oxytocin use, high parity, preterm delivery, history of uterine

surgery, and IVF conceptions. History of a prior retained placenta and congenital

uterine anomalies also appear to be risk factors. Management entails manual

removal of the placenta with adequate analgesic, as medical intervention alone has

not been proven effective. Complications can include Major Hemorrhage,

Endometritis, or retained portions of placental tissue, the latter of which can lead to

delayed hemorrhage or infection. Prophylactic antibiotics can be considered with

manual placenta removal, though evidence regarding effectiveness is inconsistent. If

hemorrhage is encountered, deployment of a massive transfusion protocol, uterine

5
evacuation with suction, and use of intrauterine tamponade, as with an intrauterine

balloon, should be initiated immediately. When a separation plane between the

placenta and uterus is particularly difficult to create, PAS should be considered, and

preparations should be made for hemorrhage and hysterectomy. Patients with risk

factors for retained placenta should have a laboratory sample sent for blood type and

antibody screening on admission to labor and delivery, and plans should be made for

appropriate analgesia and preparations for hemorrhage if a retained placenta is

encountered.

In this study, we sought to explore the variation in reported rates of retained

placenta. We will learn more about the causes, symptoms, and treatment, we will

share this information with the public. We chose this study because this will give

awareness not only to us but also to the people who will be reading this in the future.

This case study will help not only us but also the public to understand the risk factors

and danger of this complication. Everyone, not only pregnant women will be

educated with this study. People will be more open about the importance of prenatal

check-up.

I. DEMOGRAPHIC DATA

A. Initials of Clients’ Name: F S M Date of Admission: Nov. 28,2022

B. Address: General Trias Cavite Time of Admission: 3:00 PM
C. Age: 36 y.o Date of Interview: Jan. 12, 2023
D. Birth Date: September 10,1986 Primary Informant: Client FSM
E. Birthplace: Manila Secondary Informant: Mother
F. Sex: Female Other Data Sources: Laboratory
G. Civil Status: Married Result & Doctor’s Findings
H. Religion: Catholic
I. Highest Educational Attainment: College Undergraduate
J. Occupation: Customer Service Representative
K. Monthly Income / Budget : 30,000

6
 Daily Consumption Monthly Expenses Per Day Expenses
Electricity 4,000/month ÷ 30 133
Water 500/month ÷ 30 17
Internet/ Load 2,000/month ÷ 30 67
Grocery 5,000/month ÷ 30 167
Food 10,000/month ÷ 30 333
LPG 800/month ÷ 30 27
Transportation 1,000/month ÷ 30 33
Total: 777
Table 1. Family Daily Expenses of client F.S.M.

II. REASON FOR SEEKING HEALTH CARE

Client FSM was admitted at ERS Maternity and Pediatric Clinic last

November 28,2022 as she is experiencing labor pains, Client FSM later delivered

to an alive baby boy at 1:15 AM, November 29, 2022, as the physician was

having a hard time getting the placenta, the client experience blood loss

estimating more than 600cc. The placenta was out at 2:00 AM but there are

some retained placenta so at 2:30 AM the client was transferred to a hospital due

to Retained Placenta v. focal Placenta Accreta for Postpartum curettage.

III. HISTORY OF PRESENT ILLNESS

Last November 29, 2022 at ERS Maternity and Pediatric Care Clinic, Client

FSM was attended by a Physician on her childbirth, client delivered a  incomplete

placenta, absorbent pad was soaked with blood and changed her pad twice with

an estimated interval of 45  minutes  because her physician took a long time

removing some fragments that remain in the uterus. Due to  heavy bleeding

clients estimated blood loss was  600cc and  blood pressure was found to be

90/60mmHg from 120/80mmHg upon delivering the baby. At 3:00 am during the

procedure the Physician ordered the attending Midwife to refer the client to the

Hospital. According to the doctors order  the reason for referral is retained

placenta via focal Placenta Accreta for postpartum curettage or possible

hysterectomy

7
IV. PAST MEDICAL HISTORY

The client does not have any past illnesses from when she was a child

up until adulthood. She says that she has no allergies to any kinds of foods,

drinks and medication. As stated by the client’s mother, client FSM has had

the following vaccines from her childhood: BCG, Hepatitis B, MMR and OPV.

During her fifth pregnancy, her doctor prescribed her purple tablets or

Methergine tablets to help her postpartum bleeding to stop, Sangobion for her

iron supply and Malunggay capsules to help her in breastmilk production.

Client FSM stated that she was fully immunized by tetanus toxoid as well as

COVID vaccine with no booster.

V. OBSTETRIC – GYNECOLOGICAL HISTORY

The client had her menarche when she was 10 years old. Client has a

regular menstrual cycle, her menstruation usually lasted for 4-5 days, she

used 3-4 pads a day with moderate flow. The Client’s OB Score is G5P5

(5005). The client had her first born on May 25, 2005 (Male) at Ospital ng

Sampaloc, Manila. The second child was also born at Ospital ng Sampaloc,

Manila on May 15, 2006 who is also a male. The third and fourth child was

both born at ERS Maternity & Pediatric Care Clinic on September 20, 2014

(Female) and May 13, 2018 (Male). There are no complications in the delivery

of the Client on all four pregnancies. Lastly the fifth born (Male) was also born

at ERS Maternity & Pediatric Care Clinic last November 29, 2022

8
9
10
VI. HEREDO – FAMILIAL HISTORY
A. GENOGRAM

Figure 1. Genogram of Client FSM

The Figure shows the Genogram of Client’s FSM Family starting from her Grandparents up to her generation. The Genogram shows that

there are no illnesses in her family except for one. Her Grandfather from Father side has diabetes, other than that all her family members is still

alive and well. There is no significant illness on the genogram that can be a factor on the client’s complication, she is the first one who

experience this in the Family.

11
B. FAMILY APGAR

Constructs Questions Almost Some of Hardy

Always the Time Ever
(2) (1) (0)
Adaptation I am satisfied with the help that I 2
receive from my family when
something is troubling me.
Partnership I am satisfied with the way my 2
family discusses items of
common interest and shares
problem-solving with me
Growth I find that my family accepts my 1
wishes to take on new activities
or make changes in my lifestyle.
Affection I am satisfied with the way my 2
family expresses affection and
responds to my feelings such as
anger, sorrow and love.
Resolve I am satisfied with the way my 2
family and I spend time together.
TOTAL 9
Table 2. Family APGAR of client F.S.M

Table 2 shows the family APGAR score sheet of client F.S.M, A total score of

9 points indicates that Client's F.S.M has a high functioning family. The client always

receives full support from her family, when dealing with any kind of hardship her

family is always at her back no matter what happens. The client and her family have

open communication to settle things. Even small talk will give her a sense of hope

and inner strength to fight problems. If the client wants to try specific hobbies or

specific activities, she asks for her family suggestions if it is good to try or not. The

client makes sure that her family will allow her to do those things. The client also

stated that her family is loving and caring. Client also added she loves the way her

family finds time to have quality time together. The client and her family have a good

and harmonious relationship.

12
VII. DEVELOPMENTAL HISTORY
Erik Erickson’s Psychosocial Development
Stages Specific Task(s) Age Evidence of Milestone Achievement
Trust vs. Mistrust
In the first stage, a The client’s mother stated that when client FSM
Infancy
child develops their was still a child, she felt safe and secure in her
1 (0 to 18
sense of trust to carry environment because she has a good bond with
months)
them into relationships her family as well as other relatives.
and feel secure.
Autonomy vs. Shame
and Doubt
On the second stage, Client FSM’s mother stated that when she was
a child is encouraged Toddler a toddler growing up, she taught her to be
2 in their increase of (2 to 3 independent by letting her eat by herself as well
independence to be years old) as letting her walk by herself. Her mother
more confident and encouraged her by acknowledging her efforts.
secure on their own
ability to survive.
During this time, the client started going to
school at around 4 or 5 years old. She says that
she was very shy and scared at first because
she was left by her mother at school. But as
Initiative vs. Guilt
time goes by, she says that she was able to feel
The third stage Preschool
comfortable thanks to her nice friends and
3 involves the child (3 to 5
classmates at school. That is why she was able
interacting with other years old)
to adjust to her new environment. At this stage,
children.
the client says that she enjoys being with
people her age group and that she feels great
when her teachers and parents acknowledge
her efforts at school.
Industry vs. Inferiority
At this stage, the child
The client was more aware of having
feels the need of School-
competition inside the classroom, so she was
approval from the age
4 encouraged more to excel more at school and
society and begins to (6 to 11
she was receiving encouragement from her
develop a sense of years old)
parents and teachers.
pride in
accomplishments.
Identity vs. Role
Confusion During adolescence, the client knows where
The fifth stage is she excels. She is aware of her strengths and
where the child has to Adolescen weaknesses. She tries to explore more on her
learn certain roles ce hobbies and abilities, and she thinks that she
5
they will be occupying (12 to 18 still needs to improve in a lot of things. She
as an adult as well as years old) says that she wants to work abroad if she is
the changes of the given the chance. She was willing to try
body image as an something new.
adolescent.
Intimacy vs. Isolation
The client is in her 20’s and is now curious
On the last stage, they
about having an intimate relationship with
begin to share more of
others. While being in a relationship makes the
themselves more Young/
client realize that being in a relationship with
intimately to others. Early
someone makes you realize that
6 And successful adulthood
communication is really the most important
completion on this (19 to 40
thing while having a relationship with someone.
stage may result into years old)
While having a relationship with someone, you
happy relationships as
will be able to share parts of yourself to other
well as having sense
people.
of commitment.
Table 3. Developmental History of Client F.S.M. using Erik Erikson’s Psychosocial
Development.

13
 The model used to determine the developmental history of the client was Erik

Erikson’s Psychosocial Development Theory. Table number 3 shows the milestones

of the client from infancy up to her ongoing adulthood. During infancy, the client’s

mother stated that she has a good bond with her family because the client was letting

the people around her gain her trust. As the client went to preschool, her mother

stated that client FSM thought that being with people the same age as her. It has

given her confidence in doing what she loved. Growing up, client FSM was

encouraged to do things independently according to her accord. She was able to

explore and develop intimate relationships with other people. Client FSM stated that

she was happy and contented with the relationships she had with her family and

friends.

VIII. GORDON’S 11 FUNCTIONAL HEALTH PATTERN

Marjorie Gordon's 11 Functional Health Pattern Model was used to interview

Client FSM. Through this model, the client was able to express, reveal and

emphasize her past and current health state as well as her health management.

A. HEALTH PERCEPTION – HEALTH MANAGEMENT

Client FSM stated that ever since she was a child, she was taught to believe that

medicine intake and going to the doctor for checkups are the cure for illnesses. So

when she got pregnant from her first up until her fifth child, she was always checked

by an Obstetrician. She feels at ease when she is being checked by a licensed

physician. The client also stated that she is trying her best to eat healthily because

she is now conscious of her health condition. She stated that having good health can

lower the risk of getting ill. The client wants her family to value health because it may

affect their daily lives.

14
 B. NUTRITIONAL – METABOLIC

Aside from the medications prescribed by the doctor, client FSM does not

take any other multivitamins as of now. The client consumes about 2,000-2,200ml of

fluid daily. According to the client, she prefers rice more than bread but now, she tries

to lessen her intake of rice since she doesn’t want to gain weight that much. Table 4

shows the 3-day diet recall that was created with the client during the interview.

*3-day Diet Recall

MEALS January 10, 2023 January 11, 2023 January 12, 2023
(TUESDAY) (WEDNESDAY) (THURSDAY)
Breakfast (7:30 1 serving of pancit 4 pcs of pan de sal (480 1 cup of rice (200 kCal)
am) bihon (100 kCal) kCal) 2 pcs. of longganisa
2 slices of wheat loaf 3 tsp. of butter (135 kCal) (244kCal)
bread (100 kcal) 2 glasses of water 3 strips of bacon (135
1 cup of coffee with ½ 1 cup of coffee with ½ tsp kCal)
tsp of sugar and milk of sugar and milk (60 kCal) 1 cup of coffee with ½
(60 kCal) 1 cup of taho w/ syrup & tsp of sugar and milk (60
2 glasses of water sago (80kCal) kCal)
2 glasses of water
Snacks 1 whole sliced apple (40 2 pc. of ensaymada (200 2 pcs. of sliced wheat
(10:30am) kCal) kCal) loaf bread (100 kCal)
1 ½ pc. of boiled corn 2 glasses of water 2 tsps. of peanut butter
(150 kCal) 1 tetra brick of orange (45 kCal)
2 glasses of water juice (140 kCal) 2 glasses of water
Lunch 1 cup of rice (200 kCal) 2 cups of rice (400 kCal) 2 cup of rice (400 kCal)
(12:30pm) 2 pcs. of hotdog (244 2 pcs. of fried chicken 2 slices of fried porkchop
kCal) wings (172 kCal) (172 kCal)
1 pc. of chicken nugget 2 glasses of water 2 glasses of water
(86 kCal) 1 bottle 290ml soft drink 1 bottle 290ml soft drink
2 glasses of water (100kCal) (100kCal)
Snacks (3:30pm) 2 pcs. of egg sandwich 1 slice of sponge cake 2 slices of wheat loaf
(445 kCal) (100 kCal) bread (100 kCal)
1 cup of coffee with ½ 1 pc. of ensaymada (100 2 tsp. of peanut butter
tsp of sugar and milk kCal) spread (45kCal)
(60 kCal) 1 cup of coffee with ½ tsp 2 glasses of water
5 pcs. pastillas candy of sugar and milk (60 kCal)
(100 kCal) 2 glasses of water
2 glasses of water
Dinner (8pm) 2 cups of rice (400 1 cup of rice (200 kCal) 1 cup of rice (200 kCal)
kCal) 1 serving of noodles with 1 slice of pork pata
2 slices of beef egg (186 kCal) (86kCal)
caldereta (344 kCal) 2 glasses of water 2 pcs. of baby potatoes
2 glasses of water 1 whole avocado w/ 2 (276 kCal)
tsps. of condensed milk 2 glasses of water
(65 kCal)
Snacks 1 cup of coffee with ½ 1 cup of coffee with ½ tsp 1 cup of coffee with ½
(10:30pm) tsp of sugar and milk of sugar and milk (60 kCal) tsp of sugar and milk (60
(60 kCal) 2 glasses of water kCal)
8 pcs. of pastillas candy 1 pack of chocolate 2 glasses of water
(160 kCal) sandwich crackers (150 1 pack of strawberry
2 glasses of water kCal) sandwich crackers (150
kCal)
Total Calorie 2,549 kCal 2, 688 kCal 2,373 kCal
Intake
Total Fluid Intake 2,200ml 2,200ml 2,200ml
Table4. 3-Day Diet Recall of Client F.S.M.

15
 Table 4 shows the 3-Day diet recall of Client FSM. On January 10, 2023, she had

a total of 2,549 kCal intake. On the next day, January 11, 2023, she consumed 2,688

kCal intake. And on January 12, 2023, she had a 2,373kCal intake. The Client’s

meals on January 10 and 11 succeeds the needed calorie intake by her body as a

Lactating Mother which is 2,339 kCal intake per day.  

C. ELIMINATION

According to the client she has a normal daily bowel movement, it is usually dark

brown in color. She also stated that she experienced discomfort during elimination

because of the stitches she had. Furthermore, the client also stated that during

daytime she usually urinates for about five times or more, and the urine color is

usually yellow.

D. ACTIVITY – EXERCISE

Client FSM has been observed before, during and after the course of the

interview. It has been observed that the client:

16
 *7-Day Activity Table

Table 5. 7-Day Activity Table of Client F.S.M.

Client FSM's 7-Day Activity Table is displayed. The table shows that the client

was able to sleep early at night and woke up early the following day but in the middle

of her sleep she would get up to babysit and feed her baby. She typically starts her

day by cooking meals for her family. She would also clean the house or take a bath

after eating. She has 1-3 hours of rest and time for errands every afternoon, in

between those times she would also babysit her baby. She would prepare dinner

after cleaning the house. The Client is currently on maternity leave so there was no

work reported in this activity table.

17
 *Katz Index of Independence in Activities of Daily Living
Activities Independence = 1 point Dependence = 0 point
Points (1 or 0) No supervision, direction or With supervision, direction or
personal assistance needed personal assistance or total
care
Bathing 1
Dressing 1
Toileting 1
Transferring 1
Continence 1
Feeding 1
TOTAL: 6
Table 6. Katz Index of Independence in Activities of Daily Living of Client F.S.M.

Table 6 displays the Katz Index of Independence in Daily Living Activities of

Client FSM. The client scored a perfect 6, which is interpreted as, the client has the

full capability to function on her own without any supervision, direction, or assistance

from other people in the indicated activities, which are bathing, dressing, toileting,

transferring, continence, and feeding.

E. SLEEP – REST

*7-Day Sleep Diary

Constructs Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Jan. 9 Jan. Jan. 11 Jan. 12 Jan. 13 Jan. 14 Jan. 15
Mon. 10 Wed. Thurs. Fri. Sat. Sun.
Tues.
Hours of 6 6 5 6 7 6 4
Sleep
Sleeping 9 PM 9 PM 9 PM 9 PM 9 PM 9 PM 10 PM
Time
Waking 5 AM 6 AM 5 AM 5 AM 6 AM 5 AM 5 AM
Time
Bedtime Watchi Movies Videos Reading Watching Watching Reading
Rituals ng Videos Videos
Movies
Feeling Refres Feeling Feeling Refresh Energetic Feeling Feeling
upon hed Tired Tired ed Tired Tired
waking up
Problem Babysi Babysit Babysitti Babysitti Babysittin Babysittin Babysitti
Encountere tting ting ng ng g g ng
d
Table7. 7-Day Sleep Diary of Client F.S.M.

Table 7 displays Client FSM's 7-Day Sleep Diary. The table shows the client does

not have sufficient sleep for all seven days because she is taking care of her 1-

18
month-old baby, her sleep ranges from 4 to 7 hours. The table shows that the client

usually sleeps before 9 pm and wakes up early because she needs to prepare food

for her family. It is also indicated that the client encountered a problem while sleeping

which is when she babysits and feeds her baby. She usually wakes up feeling tired

and refreshed but there are also days where she feels energetic.

F. COGNITIVE – PERCEPTUAL

During the interview process, client F.S.M was assessed as attentive and

oriented. She had a good memory for remembering her past events. However, she

has trouble in making decisions, especially on important matters. The client also

stated that she did not experience any form of discomfort throughout the interview

and assessment.

G. SELF PERCEPTION – SELF CONCEPT

Client F.S.M perceives herself as someone who’s always exhausted and sleep

deprived. She also stated that almost everything, she can't sleep properly and timely.

However, despite having these feelings and perceptions towards herself, she stated

that she does not lose hope, and that she always tries hard to stay optimistic and

finds a way to have a proper rest and time to herself.

19
 H. ROLE – RELATIONSHIP
*Ecomap

Figure 2. Ecomap of Client F.S.M.

Upon interview, the client stated that she has a relationship with her husband for more than decades. As a mom of 5 children, the client

stated that she really makes sure that she can provide the needs of her children. As a wife, the client stated that she and her husband work

hand in hand in guiding their children and provide the needs for their children. As a wife she can provide the needs of her husband by having

quality time and good communication. The client stated that having her own family is not an excuse to leave or ignore the parents. As a child,

she always took care of her parents by supporting them financially, emotionally and physically. The client stated also that she always prioritizes

the health of her parents too. The client as a child has good manners to her parents and has a pure heart in her parents. Client FSM and her in-

laws have a good relationship. Because they have good communication, love, and patience with each other The client has good manners and

always respects her in-laws.

 I. SEXUALITY – REPRODUCTIVE

Client FSM stated that they have been Married for a long time now, despite that

they still make sure to have time for each other especially during this time where both

of them are home. Client also stated that upon giving birth up to the time of the

interview they haven’t engaged in any sexual activity because of her stiches, The

Client politely refused the questions with regards to what she feels before, during and

after the intercourse, she said that this type of information is confidential for her. She

has now five children and is planning to use Ligation as her Family planning method.

J. COPING – STRESS

Client FSM stated that after she was diagnosed with retained placenta, she

began to wonder what is the reason behind it. She claims that she has an open-

relationship with her family, especially with her supportive husband who always

makes her laugh and helps her to endure everything. She also stated that her work

from home set-up is more appropriate for her as she can get along with her kids

more and be a mother to them.

K. VALUE – BELIEF

Client FSM is a Roman Catholic, as she stated that ever since as a kid, she is a

religious type as her family somehow serve at catholic churches before. When the

pandemic started, they didn't visit churches as often as before due to COVID-19. She

values her family as she grew up in a Filipino cultured family, she also stated that all

her life only revolves on her family and work.

IX. COMPREHENSIVE PHYSICAL EXAMINATION

A. Vital Signs
T = 36.2OC Date / Time of Exam: 01/12/23
PR = 71 bpm
RR = 19 cpm
BP = 110/80 mmHg
Pain

Client FSM did not experience any sign and symptoms regarding any

complications about her placenta, she is not even well informed that she is

considered as high-risk pregnant due to multiparity and maternal age as the client

stated. She is advised to have a complete bed rest and eat healthy foods rich in iron.

According to the client, on a pain scale of 1-10, 10 being the highest, she

experienced an average kind of pain and rate 7/10. After her surgery she feels numb

because of the epidural anesthesia, but right after it started to ache but is tolerable

for her. She also stated that she is just too tired from the delivery and the surgery

that’s why.

B. Anthropometric Data
Height = 149.86cm BMI = 29.4 (Overweight)
Weight = 66kgs. IBW = 46kgs.

C. General Appearance

Client FSM weighs 66 kgs. and 149.86 in height, as shown by her 29.4 Body

Mass Index. The client's weight is not proportion for her height, her body is not

proportionate and have a slightly bad posture. Her feet and legs are normal as she

walks toward us as we observed during our interview. Client FSM is very conscious

about herself, especially when the pandemic starts, she usually takes a bath twice a

day if she goes outside for the day and once if she just stays at home. She said she

doesn't need to worry about her looks as she is a mother of her five children now, but

she looks neat and clean. She uses tawas as her natural deodorant because it

doesn’t harm the skin and more comfortable with it. She brushes her teeth twice to

thrice a day and also uses mouthwash and sometimes floss her teeth. Generally, the

patient's cleanliness and grooming were decent and presentable.

There are no indications that the patient will cover the facts about her

condition from others. Even though she occasionally, but not always, forgets things

or events, she was in good mental health and wasn't very disturbed by it because it

22
was only minor things that weren't a huge concern, like turning out the lights and

closing the door. She also responded to essential concerns.

The client provides thorough responses to the inquiries. She is a good

example of a true Filipino citizen as she smiles and welcomes us as we conduct the

interview. The entire interview, she conducts herself politely and gives us respect.

She also responds nicely to our inquiries. As she shared her journey, she spoke

smoothly throughout the interview and conveyed her ideas as if she were telling a

story, demonstrating that she is at ease discussing those topics. She articulated her

ideas in an intelligible, well-organized, and pertinent manner. She also offers some

stories, particularly those pertaining to her family and their history.

D. Focused Assessment

Body Part Examined Actual Finding Normal Finding Clinical Significance

INTEGUMENTARY SKIN I: Skin is in uniform color, Increased melanin

I: Skin has a slight
SKIN discoloration on neck,
I: color, armpit, No presence of
uniformity, edema, Lesions and Edema and
lesions no foul odor.
P: Skin is smooth, warm to
P: moisture, temp., touch and has good
turgor elasticity and turgor.
unblemished, no
presence of any lesions
and edema, no foul odor.
P: Skin is smooth, dry,
warm to touch, has good
skin turgor and mobile.
greater than a person’s
genetic norm caused by
pregnancy.
(BATES, Pocket Guide
to Physical
Examination, page 86)

BREAST AND BREAST AND AXILLAE I: round shape, slightly Both the nipple and the
AXILLAE unequal in size; generally areola are well supplied
I: Breasts are equal in symmetric. Skin uniform with smooth muscle
I: breast for size, that contracts to
size, everted, and in color; smooth and
symmetry, contour or express milk from the
rounded. The color is intact; striae, moles, and
shape, discoloration, ductal system during
uniform to the other parts, nevi. no retractions, no
retraction, hyper- breast-feeding. (BATES,
smooth and intact. There is swelling, no edema
vascularity, swelling, Pocket Guide to
no swelling or edema present
edema. Physical Examination,
present.
: round or oval, color page 299)
: areola for size, shape,
symmetry, color, : Areola is symmetrical, varies from light pink to
surface characteristics, rounded, dark brown in dark brown, irregular
masses, lesions color. Does not have any placement of sebaceous
masses or lesions. glands on the surface of
: nipples for size, shape,
the areola.
position, color, : The nipples are small,
discharge, lesion rounded, and inverted. : round, everted, and
P: lymph nodes, breast, Both points in the same equal in size; similar in
areola & nipples for direction and does have color; soft and smooth;
tenderness, masses, discharge (Breastmilk) both nipples point in the
same direction; no

23
nodules, discharge P: Breast examination was discharge except for
not done because the postpartum women
client refused to conduct (breastmilk), no lesions.
the examination

ABDOMEN ABDOMEN I: Unblemished skin, Purplish striae and

uniform in color, linea nigra are normal.
I: skin integrity, contour symmetric contour, not (BATES, Pocket Guide
I: The skin is intact,
& symmetry, hernia, to Physical
symmetrical, Slight distended. Symmetrical
distention (girth), Examination, page 367)
vertical line discoloration movements caused by
movements associated
(Linea Nigra), stretch respirations.
w/ respiration,
marks and not distended,
peristalsis & aortic
The movements of
pulsations
abdomen is associated
with respirations.

GENITALS GENITALS For Females: Scars from an

For Females:
I: pubic hair distribution,
amount, characteristics;
its areas for parasites,
inflammation, swelling,
lesions
: clitoris, urethral and
vaginal orifices for
inflammation or
discharge
For Females:
I; Pubic hair is evenly
distributed, there is no
inflammation, swelling or
any lesions. Scars on the
perineum
: No discharge or
inflammation in the clitoris,
urethral and vaginal
orifices.
I: Evenly distributed pubic
hair, no inflammation,
swelling or any lesions.
: No discharge or
inflammation in the
clitoris, urethral and
vaginal orifices
episiotomy, a perineal
laceration to facilitate
delivery of an infant, or
from a perineal
laceration may be
present in multiparous
women. (BATES, Guide
to Physical
Examination and
History Taking page
422)

Table 8 Focused Assessment of Client F.S.M.

X. DIAGNOSTIC TEST
A. Non – Invasive
Specific Test Actual Finding Normal Finding Clinical Significance

N/A N/A N/A N/A

Table 9 Non- Invasive Diagnostic Tests of Client F.S.M.

B. Invasive
Specific Actual Normal Finding Clinical Significance
Test Finding
CBC WBC: 35.6 5.0 – 10x 109/L
(Novembe RBC: 3.23 F: 4.0 – 4.5x10* 12/L A low hemoglobin count isn't always a sign of
r 30, 2022) M: 4.5 – 6.2x10* 12/L illness — it can be normal for some people. Women
with menstrual periods and pregnant women
commonly have low hemoglobin counts (CLINICAL
F: 120 - 160 g/L HEMATOLOGY 5th EDITION by TURGEON page 170)
Hemoglobin:
87 M: 140 -170 g/L
When the hemoglobin level is low, the patient has
anemia. An erythrocytosis is the consequence of
too many red cells; this results in hemoglobin levels
Hematocrit: F: 0.37 – 0.47
above normal (CLINICAL HEMATOLOGY 5th
0.37 M: 0.45 – 0.52
EDITION by
TURGEON page 109)
Platelet 150,000 –
Count: 400,000/cumm

24
 ADEQUATE
Table 10 Invasive Diagnostic Tests of Client F.S.M.

The laboratory findings that were performed to client FSM, shows that there

are some abnormal findings found on her CBC last November 30, 2022. For RBC the

result is 3.23 the normal values of RBC for females is 4.0 – 4.5. Her hemoglobin is 87

and the normal values for females of hemoglobin is 120 - 160 g/L. The hematocrit is

0.37 and the normal values of females for hematocrit is 0.37 - 0.47.

25
XI. PATHOPHYSIOLOGY

Figure 3. Pathophysiology of Retained Placenta

 Retained Placenta was identified as the client's condition, it is when the

placenta does not deliver completely from the uterus after delivery. Mothers who

experience Placenta Accreta has a higher risk for heavy bleeding or Postpartum

Hemorrhage. Bleeding would not stop until the fragments are completely removed

from the uterus. There is a lot of factors why Retained Placenta occurs, on the

Client’s case she experienced heavy bleeding after delivery because of the retained

placental fragments. There is no signs or symptoms in Retained Placenta because

this happens at the latter part of delivery.

Factors why client FSM was diagnosed with retained placenta was due to her

age, FSM is a 36 years old female, Maternal age is very important as 35 years old

and above are considered as high risk pregnancy. Multiparity can also be one of the

causes of retained placenta, as our client OB score is gravida 5 parity 5 (5005), The

risk of Retained Placenta increases as your number of pregnancies increases. FSM

had gone through an epidural anesthesia to perform a dilation curettage procedure to

remove the retained tissue that is planted deeply in the uterus. Client FSM is fully

recovered as she verbally stated but she is still on her maternity leave and advised to

rest well by her physician to be physically and mentally prepared for ligation.

A. ANATOMY
 The organs of the female reproductive system produce and sustain the

female sex cells (egg cells or ova), transport these cells to a site where they may be

fertilized by sperm, provide a favorable environment for the developing fetus, move

the fetus to the outside at the end of the development period, and produce the female

sex hormones. The female reproductive system includes the ovaries, Fallopian

tubes, uterus, vagina, accessory glands, and external genital organs. Reproduction is

all about making babies, and the female reproductive system is specialized for this

purpose. Its functions include producing gametes called eggs, secreting sex

hormones (such as estrogen), providing a site for fertilization, gestating a fetus if

fertilization occurs, giving birth to a baby, and breastfeeding a baby after birth. The

only thing missing is sperm Pregnancy is the carrying of one or more offspring from

fertilization until birth. This is one of the major functions of the female reproductive

system. The maternal organism plays a critical role in the development of the

offspring. (Suzanne Wakim Mandeep Grewal,2022)

B. CLIENT - BASED
1. A retained placenta might occur because the placenta becomes trapped
behind a partially closed cervix or because the placenta is still attached to
the uterine wall.
2. If retained placenta is left untreated, it can cause severe infection or life-
threatening blood loss.
3. Losing lots of blood quickly can cause a severe drop in your blood
pressure. This may lead to shock and death if not treated.

4. Your doctor may be able to remove the placenta by hand, but this carries
an increased risk of an infection.
5. The placenta grows into the uterus wall, one of the factors of retained
placenta.
6. A hysterectomy may be required after delivery to remove the placenta and
end blood loss.

29
XII. CASE MANAGEMENT
A. Drug Study
Drug Features Therapeutic Effects Nursing responsibilities
Brand Name: Methergine Indication Contraindication Desired Untoward Before:
Methylergometrine Methylergometrine Methylergometrine Dizziness -Check blood pressure, monitor respiratory rate,
Generic Name: Maleate is indicated Maleate is Maleate desired is to Headaches heart rate, and uterine response frequently during
Methylergonovine as postpartum, or contraindicated in, prevent or treat Nausea medication administration
maleate post abortion Hypersensitivity. bleeding from the Vomiting -Assess for any evidence of bleeding before
hemorrhage caused uterus that can happen Chest pain administration
by uterine atony or Lactation: The baby after childbirth Muscle Pain -Educate the client about their medication
Dosage: 0.2mg
subinvolution should not Weakness
Frequency: 3x a day or
every 8 hours be breastfeed during After:
Route: Oral treatment -Notify physician if BP suddenly increases or if
there are frequent periods of uterine relaxation.
Brand name: Malunggay Malunggay capsule is Malunggay capsule is Malunggay Capsule Rash, itching, Before:
Capsule a well-known health contraindicated in desired is to boost swelling -Advise the client to take iron supplements an hour
Generic Name: Moringga supplement to help patients with immunity. (especially of before meals for maximum absorption
Olifera stimulate milk Hypercalcemia, the face,
secretion. A Hyperkalemia, tongue, throat) After:
Dosage: 500mg supplement that Sarcoidosis, Severe -Advice client that stools may become dark green
Supports Breastfeeding
Frequency: Once a day improves to letdown Nephrolithiasis, Severe dizziness. or black and this change is harmless
Mothers
Route: Oral the milk and Renal failure and Trouble
increases milk Hypersensitivity. breathing
production. It is to protects against free Hypercalcemia,
known as lactation radicals that can Nausea
enhancer damage hair and skin Vomiting.

Brand name: Treatment for a wide It is contraindicated Multivitamins + Iron Constipation Before:
SANGOBION IRON+ range of anemias; with impaired renal & Calcium Sangobion dark stool -Advice client to take medicine once a day
CAPSULE Iron deficiency functions, Iron desired is to helps Nausea/ -Educate the client about her medication.
Generic Name: anemia during nephrolithiasis replenish iron stores Vomiting
Multivitamins & Minerals pregnancy growth. hypersensitivity to and increases red Abdominal After:
megaloblastic and multivitamins blood cell levels in the Pain -Discontinue if side effects may occur Assess
Dosage: 250mg macrocytic undiagnosed anemias. body palpitations history of allergic reaction with drug.
Frequency: Once a day hypochromic anemias
Route: Oral Chest pain

30
Table 11 Drug Study of Medication taken of Client F.S.M

31
XIII. NURSING MANAGEMENT
A. Listing of Nursing Problems
I. Severe Bleeding due to Retained Fragments
II. Low Hemoglobin
III. Multiparity
B. Prioritization of Nursing Problems
Problem 1:  Severe Bleeding due to Retained Fragments 
Criteria Weight Multipli Computati Justification
er on

Nature and 3 Actual Problem 1 3/3 x 1 = 1 Severe Bleeding due to Retained

Extent 2 Risk / Potential fragments can cause a severe drop
1 Wellness State in blood pressure. It may lead to
shock and death if not treated.

Modifiability 2 Easily Modifiable 2 1/1 x 2 = 2 Partially Modifiable. A health care

1 Partially provider can treat severe bleeding
Modifiable by finding and stopping the cause of
0 Non-Modifiable the bleeding as soon as possible.

Preventive 3 High 1 2/2 x 1 = 1 It is moderately preventable

Potential 2 Moderate because maintaining a healthy
1 Low pregnancy can help but there are
also risk factors that is irreversible.

Salience 2 Needs immediate 1 2/2 x 1= 1 It needs immediate action because

attention. severe bleeding is a life threatening
   action condition that may lead to death if
1 Not needing not treated properly and
immediate.
   attention
immediately.
0 Not perceived as
a problem/
condition needing
change

TOTAL 5 Priority # 1

Table 12.1 Severe Bleeding due to Retained Fragments

Problem 2:  Low Hemoglobin 
Criteria Weight Multi Computat Justification
plier ion

Nature and 3 Actual Problem 1 2/3 x 1 = Low hemoglobin is a condition in

Extent 2 Risk / Potential 0.67 which the body lacks enough
1 Wellness State healthy red blood cells to carry
adequate oxygen to the body tissue,
It  can make you feel tired and
weak.

Modifiability 2 Easily Modifiable 2 2/2 x 2 = 2 Easily Modifiable. It can be alter with

1Partially the use of medications and blood
Modifiable transfer.
0 Not Modifiable

Preventive 3 High 1 3/3 x 1 = 1 It is highly preventable because

Potential 2 Moderate Eating food that rich in iron such as
1 Low meat, chicken, fish, eggs, dried
 beans and fortified grains, together
with medications. This can help her
body to go back in normal state.

Salience 2 Needs immediate 1 2/2 x 1 = 1 It needs immediate action to prevent

attention complication, consulting healthcare
   action provider can  explain the possible
1 Not needing complications or side effect 
immediate
   attention
consider specific circumstances,
0 Not perceived as including other health conditions,
a problem/ and medications
   condition needing
change

TOTAL 4.67 Priority # 2

Table 12.2.Low Hemoglobin 

Problem 3:  Multiparity 

Criteria Weight Multipli Computat Justification

er ion

Nature and 3 Actual Problem 1 2/3 x 1 = Client's maternal age is  36 and with
Extent 2 Risk / Potential 0.67 an OB score of G5P5(5005) which
1 Wellness State mean the risk of unfavorable
outcomes can increase her chances
of pregnancy complications.

Modifiability 2 Easily 2 1/2 x 2 = 1 Partially Modifiable This situation or

Modifiable problem can be solved by informing
1 Partially having a family counseling to 
Modifiable choose method of  family planning.
0 Not Modifiable

Preventive 3 High 1 3/3 x 1 = 1 Preventative Potential is high

Potential 2 Moderate because  the more times a woman
1 Low becomes pregnant and gives birth,
the less efficient her uterus is at
contracting and returning to its
normal size. This can cause
problems during and after her labor

Salience 2 Needs 1 2/2 x 1 = 1 It needs immediate action and

immediate immediate attention because
attention multiparity is a great risk for many
   action fetal and maternal complications.
1 Not needing
immediate
   attention
0 Not perceived
as a problem/
   condition
needing change

TOTAL 3.67 Priority # 3

Table 12.3 Multiparity 

Health Problems Score

Severe Bleeding due to Retained Fragments 5

33
 Low Hemoglobin 4.67

Multiparity 3.67

Table 13. Problems ranked according to the Prioritization.

              Based on our findings. There are three lists of problems contained in the

case presentation, these are Severe Bleeding due to Retained Fragments, Low

Hemoglobin and Multiparity. Each problem had a computation which showed where

or what the location of each problem was. First, Severe Bleeding due to retained

Fragments has a total score of 5. Second, Low Hemoglobin with a total score of 4.67

and finally Multiparity with a total score of 3.67.

34
XIV. PLANS FOR NURSING ACTION
Problem #1: Severe Bleeding Due to Retained Fragments
Assessment Diagnosis Planning Implementation Evaluation
Subjective Independent Rationale
“Marami parin yung Risk for ineffective tissue After 2 hours of  Establish rapport.  For nurse/midwife-client After 2 hours of
nararamdaman kong perfusion related to intervention, the client relationship. intervention, the goal
nalabas sakin na dugo.” severe bleeding due to will demonstrate  Assess  The amount of blood during was not met because
as stated by the client. retained fragments. adequate perfusion characteristics and first few hours after delivery the patient was
and stable vital signs. amount of blood. should be no more than one referred to the other
Objective saturated perineal pad per facility to receive
 Vital sign taken as hour. D&C procedure.
follows:
 Monitor client’s vital
CR: 65 bpm  Rise in pulse rate may indicate
RR: 22 cpm signs.
the inadequate blood volume
T: 36.7 °C and decrease in blood pressure
 Capillary refill: > 3 may also occur.
seconds
 Pale lips  Gently massage the  To help expel blood clots and
 Pale conjunctiva fundus of the uterus to check the tone of the uterus
of the client. to prevent excessive bleeding.
It will also help in making the
uterus firm and contracted.

 Count and weigh the  Estimated count of blood loss

client’s perineal in given lengths of time can be
pads. formed.

 Provide comfort to  For the client to be relaxed and

the client such as it may enhance the client’s
back rubs, deep coping abilities by redirecting
breathing. As well as their attention.
instructing the client
in relaxation
exercises.
Dependent
Administer medications
35
 as ordered. To promote contraction and to
prevent further bleeding.
Table 14.1 Health Care Plan on Severe Bleeding Due to Retained Fragments

Problem #2: Low Hemoglobin

Assessment Diagnosis Planning Implementation Evaluation
Subjective Independent
“Ramdam ko na hindi pa Fatigue related to  The client will  Establish rapport.  For nurse/midwife-client After the interventions,
ganon ka okay yung diminished oxygen- demonstrate relationship. the client’s goal was
katawan ko, siguro naga- carrying capacity of interventions partially met.
adjust pa tsaka medyo blood as evidenced by to reduce  Monitor client’s vital  Rise in pulse rate may
puyat kasi nagpapa dede expresses tiredness. fatigue. signs. indicate the inadequate
ako ng anak ko.” As  The client will blood volume and
verbalized by the client. identify the decrease in blood
factors that pressure may also
Objective aggravate occur.
 Laboratory result: feelings of  Provide comfort to
 Pale lips tiredness.  For the client to be
the client such as
relaxed and it may
 Pale conjunctiva back rubs, deep
enhance the client’s
 Looking tired. breathing. As well as
coping abilities by
instructing the client
redirecting their
in relaxation
attention.
exercises.
 It’s important to instruct
 Advise client to eat
client to eat foods with
foods that are rich in
essential nutrients to
iron, folic acid, and
promote RBC
vitamin B12.
formation.

 Encourage the client  Verbalization of their

to verbalize feelings feelings will help them
about their to cope with their
limitations. condition.

36
 Dependent To promote blood supply and
Administer medication as prevent further complications.
per doctor’s order.
Table 14.2 Health Care Plan on Low Hemoglobin

Problem #3: Multiparity

Assessment Diagnosis Planning Implementation Evaluation

Subjective Independent After the
“nakalima na nga ako High-risk Pregnancy due - The client will  Discussing  to give the client interventions, the client
dahil sa pills, to lack of Family have about the risk in more insight about was able to meet the
nakakalimot din kasi planning counseling knowledge pregnancy her status. goal:
ako ng paginom kaya about the risk 1. Knowledge
ngayon di ko na din in pregnancy.  Establish  For nurse/midwife- about the risk
alam anong rapport. client relationship. in pregnancy
gagamitin.” As - The client will 2. Choosing the
verbalized by the know what  To provide more right family
client. family options for the planning
 The client will
planning client and know method.
get to choose
method suits the best family what is suitable for
Objective for her. planning method her.
 G5 P5 (5005) for her.

Dependent
Following the To promote the importance
instructions given. of health teaching.
Table 14.2 Health Care Plan on Multiparity

37
Teaching Plan
1. Severe Bleeding due to Retained Fragments

Intended outcomes Content Strategies Resources Evaluation

The client will be  Postpartum hemorrhage or severe  Visual aids or  The client was able
able to do the bleeding after birth is defined as Teaching Activity Learning informative properly listen and
following after hours blood loss greater than 1,000cc of  Lectures and Activity handouts will be was able to
of health education: blood loss. Nonetheless, having discussions  The lecture used by student understand what is
A. Able to blood loss greater than 500cc in a with the client will be midwives. retained placental
differentiate vaginal delivery is considered or the closest discussed by  Informative and fragments.
the amount abnormal. guardian of it. a student interesting  The client was able
of normal  Factors that may lead-up to severe  Question and midwife. videos regarding to stop experiencing
postpartum bleeding are: failure of uterus to answer portion. severe bleeding severe bleeding.
discharge to contract enough after vaginal  Explaining it in due to retained  The client was able
severe delivery, retained fragments, a way they can  The student fragments of to have comfortable
bleeding. maternal age of greater than 35 easily midwife will placenta. feelings and feel
B. Have knowledge years, age of gestation below understand. discuss the relieved.
about the risk in viability, anemia and prolonged risk factors  The client was able
experiencing third phase of labor. and causes of to live and do house
severe bleeding.  Understanding of normal and severe chores well and
abnormal limits of vital signs may bleeding. without feeling
help prevent problem occurrence.  The student discomfort.
C. Identify the midwife  The client
reasons of explained the understands the
experiencing ways to difference between
severe bleeding. prevent normal and
severe abnormal vital

38
 D. Knowledge bleeding due signs.
importance of to retained
why it is risk to placenta.
experience or
have bleeding.
Table 15.1. Teaching Plan for Severe Bleeding due to Retained Fragments

2. Low Hemoglobin
3. Multiparity

Intended outcomes Content Strategies Resources Evaluation

The client will be able to do  Family planning method is a Teaching Activity Learning  Visual aids or  The client was
the following after health method that helps to reduce  Lectures and Activity informative able to properly
education: the risk of maternal and discussions with  The lecture will handouts will be listen and was
newborn death or illness by the client or the be discussed by used by student able to understand
 Knowledge about preventing high-risk closest guardian a student midwives. the high-risk
the risk in pregnancy in women or of it. midwife.  Informative and pregnancy.
pregnancy preventing unplanned  Question and  The student interesting videos  The client must
 Know the pregnancy. answer portion. midwife will regarding perineal recite the risk
importance of FP  High-risk pregnancy means a  Explaining it in a discuss the high- lacerations. factors of high-risk
Methods woman and her fetus face a way they can risk factors in pregnancy.
 Choosing the above normal chance of easily pregnancy.  The client has
suitable family experiencing problems. understand.  The student understood the
planning method. midwife different types of
explained the family planning
importance of method.
choosing the
right family
planning method
Table 15.2. Teaching Plan for Multiparity

39
XV. DISCHARGE PLAN

Medication Exercise Treatment Health OPD Follow-up Diet Signs &

Education Symptoms
Methergine Type -Continue -Plan activities -Follow up check- Limits Do not hesitate to
medications as per with the client that up -Eating sweets, visit your nearest
Dosage: 0.2mg Light to moderate doctor’s order. can help reduce -ERS Maternity & salty as well as hospital if you
Frequency: 3x a intensity aerobic stress. Pediatric Care fatty foods. experience any
day or every 8 exercise (e.g. -Healthy diet Clinic -Limit until no abnormalities to your
hours walking) during the -Advise clients to caffeine intake. body.
Route: Oral postpartum period -Less caffeine drink lots of water
has the ability to intake. as well as the Inclusion
Malunggay improve mild to Eating healthy and
Capsule recommended
moderate -Exercise every non-caffeinated nutritious foods
Dosage: 500mg depressive morning. drinks. especially green
Frequency: Once symptoms leafy vegetables
a day (Lindberg, 2020) and fruits.
Route: Oral
Frequency
SANGOBION 10-20 minute walk
IRON+ CAPSULE every morning.

Dosage: 250mg
Frequency: Once
a day
40
Route: Oral
Table 16. Discharge Plan for F.S.M.

41
XVI. RECOMMENDATION

Upon assessing the client, we would like to recommend that she continue

completely taking her prescribed medications daily and maintain a healthy

lifestyle by having a proper diet such as eating foods rich in iron such as

talbos ng kamote, kangkong, all green leafy vegetables and liver to prevent

iron deficiency and to make sure that her recovery is going well and there are

no complications that may occur. We do suggest that she continuously

follows her doctor's recommendations and advice, such as complying with her

follow-up checkup to improve her current health status and to avoid further

aggravation.

We would also like to recommend doing exercise to have a better and

healthier life in all aspects. During assessment, the client perceives herself as

someone who’s always tired and sleepy. She easily loses interest and

energy, which makes things harder for her to accomplish. We recommended

for her overall emotional and mental health that she have meditation, try to be

more patient, and extend her temper by understanding and considering things

and people.

Above all, we commend client F.S.M for her cooperation and

attentiveness during the interview as well as for seeking and following a

professional’s advice when it comes to health and for her to believe and

follow it.
PAMPHLET (ENGLISH)

44
PAMPHLET (TAGALOG)

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Inpatient Sample–based analysis. American Journal of Obstetrics and
Gynecology, 217(3), 344.e1-344.e6. https://doi.org/10.1016/j.ajog.2017.05.004

Lochia (Postpartum Bleeding): How Long, Stages, Smell & Color. (n.d.). Cleveland
Clinic. https://my.clevelandclinic.org/health/symptoms/22485-lochia

Singh, A. (2020, January 3). Postpartum Hemorrhage - Causes, Symptoms,

Diagnosis, Treatment, Prevention. Medindia.
https://www.medindia.net/patients/patientinfo/postpartum-hemorrhage.htm

APPENDICES

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CONSENT FORM

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