PHINMA Saint Jude College

School of Nursing
Dimasalang, Manila

CASE DIGEST

ABRUPTIO PLACENTA

LEADERS:

LIZANDO, SEAN ANDRIE Y.

SORIANO, AUBREY

MEMBERS:

FIGURACION, LINDEL VILLIE

GARCIA, CARLA

GARCIA, JHENE REI

IBABAO, DIANNE

JANDOC, JOY MARIE

LALAGUNA, MAE

MOLINA, ANNIE

OLEGARIO, MIKAELA

PAJARILLO, KHEVIN

RADA, VANESSA

RODELAS, MARIA BAUTISTA

SANGA, ALLYSA

SANGA, JOYCE

MARCH 28, 2023

 TABLE OF CONTENTS

I. BIOGRAPHIC DATA

II. CHIEF COMPLAINT

III. ADMITTING DIAGNOSIS

III.1 HISTORY OF PRESENT ILLNESS

III.2 PAST MEDICAL HISTORY

III.3 VITAL SIGNS THROUGHOUT HOSPITALIZATION

IV. ANATOMY AND PATHOPHYSIOLOGY

V. MEDICAL DIAGNOSIS

VI. ETIOLOGY

VII. CLINICAL MANIFESTATION

VIII. LABORATORY AND DIAGNOSTIC TEST

IX. NURSING AND MEDICAL MANAGEMENT

X. NURSING THEORIES

XI. DRUG ANALYSIS

 I. BIOGRAPHIC DATA

Name: Patient X

Age:27

Gender: Female

Address: Sampaguita St, Santa Cruz, Manila NCR , First District

Birthdate: 02/16/1996

Nationality: Filipino

Birthplace: Manila

Religion: Catholic

Status: Single

Occupation: Saleslady

Number: 09380635226

Admission date: 03/06/2023

Admission time: 11:00 AM

Attending Physician: Cristina C. Tamayo, M.D

Admission Diagnosis: Abruptio Placenta; Anemia

Principal Diagnosis: Abruptio Placenta

Other Diagnosis: Anemia Severe Hypovolemic Shock

 II. CHIEF COMPLAINT

A 27-year-old pregnant woman was admitted with a heavy bleeding.

Impression: Recurrence of past medical history, IUFD (Intrauterine Fetal Demise).

III. ADMITTING DIAGNOSIS

III.1 History of Present Illness

- 27 y.o. a pregnant woman presents to the delivery room with severe anemia that
leads to hypovolemic shock.
- Patient also admitted for her hypogastric and chest pain.
- Obesity (60kg); GDM type 2

III.2 Past Medical History

- Had Dilation and Evacuation on her previous pregnancy

III.3 V/S Throughout Hospitalization (TPR sheet)

IV. ANATOMY AND PATHOPHYSIOLOGY

Reproductive System

Functions:

- Production of female sex cells.

● The Reproductive system produces female sex cells, or oocytes, in the ovaries.

-Receptions of sperm cells from the male

● The female reproductive system includes structures that receive sperm cells from the
male and transports the sperm cells to the site of fertilization.

-Nurturing the development of and providing nourishment for a new individual

● The female reproductive system nurtures the development of a new individual in the
uterus until birth and provides nourishment in the form of milk after birth.

-Production of female sex hormones produced by the female reproductive system controls the
development of the reproductive system itself and of the female body form. These hormones are
also essential for the normal function of the reproductive system and reproductive behavior.

Uterus

● Oriented in the pelvic cavity with the larger, rounded part directed superiorly.
● The part of the uterus superior to the entrance of the uterine tube is called the fundus.
● Main part of the uterus is called the body, and the narrower part, the cervix.
● Uterus is as big as a medium-sized pear.
● Perimetrium is a thin layer of tissue made of epithelial cells that envelop the uterus
● Its hollow and muscular and sits between your rectum and bladder in your pelvis

Abnormal Uterus

● Separation of placenta from the inner wall of the uterus before delivery that cause severe
bleeding later on
● Sometimes the blood remains between uterine wall and the placenta
● Uterine contraction
The Placenta

The placenta is a discoid-shaped organ weighing about 450-500g at full term. The placental
thickness is usually proportional to the gestational age. The placenta is normally located along
the anterior or posterior wall of the uterus and may expand to the lateral wall with the course of
the pregnancy.

● This is a fetomaternal organ

● It has two components:
- Fetal part- develops from the chorionic sac (chorion frondosum)
- Maternal part- derived from the endometrium (functional layer-decidua
basalis)
● The placenta and the umbilical cord is a transport system for substances between the
mother and the fetus.

Functions of Placenta

● Facilitated transport (glucose)

● Nutrition- transport nutrients and water soluble vitamins
● Active transport- Amino acid, iron, calcium
● Exchange fluid and gas transport (diffusion-oxygen,carbon dioxide,electrolytes)
● Source of nutrients and and oxygen
● It is also responsible for providing nutrition and oxygen to the fetus as well as removing
waste material.
● It is also responsible for creating a separation between the maternal and fetal circulation
(known as the placental barrier).

In summary, the anatomy and physiology of the uterus and placenta are critical in the case of
abruptio placenta. The separation of the placenta from the uterine wall can lead to significant
bleeding and compromise the health of both the mother and the fetus. Understanding the
anatomy and physiology of these organs can help healthcare providers diagnose and manage this
serious pregnancy complication.
PATHOPHYSIOLOGY

V. MEDICAL DIAGNOSIS

The 27-year-old had severe abruptions signs including heavy vaginal bleeding, abdominal
pain, back pain, anemia, hypovolemia, a tender “woody hard” uterus, decreased fetal movements
and difficulty palpating fetal parts.Vaginal bleeding occurs in 80% of patients. Bleeding may
compromise fetal and maternal health in a short period of time. Uterine activity is a sensitive
marker of placental abruption, and in the absence of vaginal bleeding, should suggest the
possibility of an abruption especially if there is a history of trauma. The presenting complaint
may be decreased fetal movements, which may indicate fetal compromise or even fetal death.
VI. ETIOLOGY/PREDISPOSING FACTOR

Postpartum hemorrhage:

During pregnancy, the placenta attaches to the walls of the uterus and provides the baby with
nutrients and oxygen. When a baby is born, the uterus continues to contract to deliver the placenta.
This is called the third stage of labor. The contractions also work by compressing the blood vessels
that the placenta attached to the uterine wall. These contractions alone may not be enough to stop
bleeding (called uterine atony). This is the cause of up to 80% of afterbirths.

Postpartum hemorrhage can also occur if part of the placenta remains attached to the wall of the
uterus or if part of the reproductive tract is damaged during delivery. Blood clotting disorders and
certain health conditions increase the risk of PPH.

It seems that this factor contributes to the leading cause of the problem (IUDF)

Stressors:

Stress is the body's response to a harmful situation whether it is real or perceived. When we feel
threatened, a chemical reaction occurs in our bodies that allows us to act in a way that prevents
injury. This response is known as the "fight or flight" or stress response. In the stress response, your
heart rate increases, your breathing speeds up, your muscles stiffen, and your blood pressure rises.
You are ready to act. This is your way of protecting yourself, but may also cause negative effects.

Due to having unhealthy habits, the client is suspected to develop malnutrition due to stress she
receives. Her obesity leads to diabetes that causes hydramnios.
VII. CLINICAL MANIFESTATION

SUBJECTIVE OBJECTIVE

The px is having: • Hemoglobin: 73

• Severe back pain • Hematocrit: 0.22

• Chest pain
• Abdominal pain • The hemoglobin of the px is low
due to the placenta separating from the wall
of the uterus that caused blood loss
resulting in low hemoglobin result.

VIII. Laboratory and Diagnostic Test

Hematology Result
03/06/23 4:10 AM

Due to severe anemia brought on by blood loss Patient X Hemoglobin (Hgb) result is 90. . Hematocrit
level, which mirrors hemoglobin value, is 0.29. Then, the RBC is determined to be low 3.15 and the
MCHC level is likewise low 32.3. Having a high 26.6 WBC count, 94 neutrophils, and a low 4
lymphocytic count raises the possibility of infection. With a platelet count drop of 167 because of blood
loss.

Hematology Result
03/06/23 5:45 PM

The result for Patient X hemoglobin (Hgb) dropped to 66. The hematocrit level is 0.20. The RBC then
drops to 1.83, and the MCHC level is uncharacteristically low. The WBC rises to 26.6; neutrophils are 94;
lymphocytes 4; monocytes 1; and stabs 1 are present.
Hematology Result
3/ 07/23 7:20 PM

Hemoglobin( Hgb) level this time is 73 due to blood transfusion .Hematocrit is 0.22 while RBC count is
2.36.The WBC value is 17.63 Then, neutrophils rise to 80 , lymphocytes is 19 and has eosinophils of 1 .

Xray Result for Chest Pain

FINDINGS:
Both lungs are clear.
The pulmonary vascular markings are normal.
The cardiac shadow is not enlarged.
anagram, lateral costophrenic sulci and bony thorax are unremarkable.

IMPRESSION:
No significant chest findings.

Ultrasound Result:

II Biometry:
BPD:5.76cm,AOG21,W4,D
OFD:
HC:21.63cm,AOG23,W5,D
AC:18.85cm,AOG23,W4,D
FL:3.51cm,AOG21,W0,D
Average of age: 22 weeks and 6 days
Electronic EDC: 7/4/2023
Estimated fetal weight: 524+76 grams
Percentile for age(HADLOCK):55.57%
Cephalic Index: 76.98% /70-86%

-Pregnancy uterine 22 weeks and 6 days by fetal biometry singleton in cephalic presentation NO
CARDIAC ACTIVITY & COLOR FLOW CONSIDER INTRAUTERINE FETAL DEMISE
HYRAMIOS.
Fundal wall placenta l,Grade II,High Lying
SEFW:524 + 78 grams, appropriate for gestational age by hadlock consider intraplacental hemorrhage.

Blood Typing Result:

-Patient x has a result of her blood typing.Her forward typing is "O"+Rh,and her reverse typing is "O".
HIV Result:

-The patient received a non-reactive HIV screening on March 01, 2023. This means that the Patient's fluid
samples did not contain HIV antigens or antibodies.

•Rapid Plasma Reagin (RPR) Result:

-The patient did not have Rapid Plasma Reagin (RPR).

•HBsAg (Screening)
- The HBsAg of the Patient resulted in normal/negative. The patient is protected and immune from
infection.

Clinical Microscopy Result

Physical Macroscopic results show a yellow tint, whereas transparency displays turbid due to infection .
The pH value is acidic (6.0). Plus one for protein results.

RBC is 0–2 and pus cells are 5-8 in the microscopic result, which shows and denotes bacterial infection.
Bacteria are therefore many.

IX. NURSING AND MEDICAL MANAGEMENT

Interventions Rationale

Position the client in a lateral or left side-lying To avoid pressure in the vena cava.
position.

Monitor maternal vital signs to establish baseline Vital signs give you a baseline when a patient is
data. healthy to compare to the patient's condition when
they aren't healthy.

Avoid performing any vaginal or any abdominal To prevent further injury to the placenta.
examinations.

Educate the client and significant others about Prompt recognition and reporting to the
prompt recognition and report of signs and healthcare provider may prevent the worsening of
symptoms of thrombosis or DIC. the condition and future complications.
 Administer blood and blood products as ordered. Blood and clotting factor replacement may be
needed because of DIC.

Administer intravenous fluids as indicated. Placental abruption requires intravenous fluids as

even with large blood losses, pulse and blood
pressure can remain within normal limits.

Provide supplemental oxygen therapy as needed. Oxygen saturation should be kept at 90% or
greater. In severe anemia, the rate of adequate
oxygen delivery is impaired.

Observe the client’s activity level, sleep pattern, These areas may be neglected because of the
appetite, and personal hygiene. process of grieving and associated depression

Support free flow of emotional expression. Only Expression of grief is influenced by

restrict behavior that is dangerous to able. cultural/religious beliefs and expectations running
well-being of patient/couple (e.g., pulling out IV, the gamut from stoic silence to screaming and
using fists to pound on abdomen). pounding one's chest/throwing objects, etc.

Refer for counseling or psychiatric therapy. if To achieve resolution of the grieving process.
necessary.

X. NURSING THEORIES

Roy Adaptation Model:

One nursing theory that is relevant to the care of patients with abruptio placenta is the Roy
Adaptation Model. This theory was developed by Sister Callista Roy and focuses on how
individuals adapt to stressors in their environment.

According to this model, when a person experiences a stressor such as abruptio placenta, they go
through a process of adaptation that involves three stages:

1. The first stage is the sensory input stage, where the person receives information about the
stressor and their environment. In the case of abruptio placenta, the patient may experience
symptoms such as abdominal pain, vaginal bleeding, and uterine contractions.

2. The second stage is the processing stage, where the person interprets the sensory input and
responds to the stressor. In this stage, the patient may experience anxiety, fear, and uncertainty
about their condition and the potential outcomes.
3. The third stage is the output stage, where the person takes action to adapt to the stressor. In the
case of abruptio placenta, this may involve receiving medical treatment such as monitoring,
medication, and potentially delivery of the baby via c-section.

Nurses using the Roy Adaptation Model can assess the patient's response to the stressor, identify
their coping mechanisms, and provide interventions that support their adaptation to the stressor.
For example, nurses can provide education to the patient and family about the condition, promote
relaxation techniques, and provide emotional support to reduce anxiety and fear. Overall, the Roy
Adaptation Model can provide a framework for nurses to support the patient's adaptation and
improve their overall health outcomes.

Orem's Self-Care Deficit Theory:

Orem's theory emphasizes the importance of understanding the patient's self-care abilities and
deficits, and the role of the nurse in promoting self-care and independence.

In the case of abruptio placenta, the nurse can use Orem's theory to assess the patient's self-care
abilities and deficits, and develop a care plan that promotes the patient's ability to care for
themselves.

Orem's theory identifies three levels of self-care: universal self-care, which includes activities
that all individuals engage in to maintain health and well-being; developmental self-care, which
includes activities that are learned and developed over time; and health deviation self-care, which
includes activities that are specific to managing illness or injury.

In the case of abruptio placenta, the nurse can assess the patient's self-care needs at each of these
levels, and develop a care plan that promotes the patient's ability to engage in self-care activities.
This may include education on healthy pregnancy behaviors, such as proper nutrition and
exercise, as well as specific self-care activities related to managing abruptio placenta, such as
monitoring for signs of bleeding or contractions.

The nurse can also provide support and guidance to help the patient overcome any barriers to
self-care, and work with the patient to identify and access resources that can assist with self-care
activities.

Overall, Orem's Self-Care Deficit Theory provides a framework for the nurse to assess the
patient's self-care needs and promote self-care and independence, which can ultimately lead to
better outcomes and improved quality of life for the patient.
Watson's Theory of Human Caring:

Watson's theory emphasizes the importance of caring as a fundamental component of nursing

practice, and the role of the nurse in promoting healing through the cultivation of a caring
relationship with the patient.

In the case of abruptio placenta, the nurse can use Watson's theory to develop a caring
relationship with the patient, based on trust, respect, and empathy. The nurse can also use caring
interventions to promote healing and improve the patient's overall well-being.

Watson's theory identifies ten "carative factors" that can promote healing and well-being: (1) the
formation of a humanistic-altruistic system of values, (2) the installation of faith-hope, (3) the
cultivation of sensitivity to self and others, (4) the development of a helping-trust relationship,
(5) the promotion and acceptance of the expression of positive and negative feelings, (6) the
systematic use of a creative problem-solving caring process, (7) the promotion of transpersonal
teaching-learning, (8) the provision for a supportive, protective, and corrective mental, physical,
sociocultural, and spiritual environment, (9) assistance with gratification of human needs, and
(10) the allowance for existential-phenomenological-spiritual forces.

In the case of abruptio placenta, the nurse can use these carative factors to guide care. For
example, the nurse can form a humanistic-altruistic system of values by prioritizing the patient's
needs and promoting their well-being. The nurse can install faith-hope by providing the patient
with information about their condition and reassuring them about the potential for recovery. The
nurse can cultivate sensitivity to self and others by listening actively to the patient's concerns and
needs.

The nurse can develop a helping-trust relationship by being present with the patient and
demonstrating empathy and compassion. The nurse can promote the expression of positive and
negative feelings by creating a safe and non-judgmental space for the patient to share their
emotions. The nurse can use a creative problem-solving caring process to identify and address
the patient's needs and concerns.

The nurse can promote transpersonal teaching-learning by educating the patient and their family
about the condition and care plan. The nurse can provide a supportive, protective, and corrective
environment by addressing the patient's physical, psychological, and social needs. The nurse can
assist with gratification of human needs by providing pain management, nutrition, and hydration.
Finally, the nurse can allow for existential-phenomenological-spiritual forces by recognizing the
patient's spiritual needs and providing care that is sensitive to those needs.

Overall, Watson's Theory of Human Caring provides a framework for the nurse to cultivate a
caring relationship with the patient, and use caring interventions to promote healing.
 XI. DRUG ANALYSIS

CLASSIFICATION/ CONTRA ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS INDICATIONS REACTION RESPONSIBIL
ACTION ITIES

Generic Name ● Antibiotics ● Treatment of ● Hyperse ● Abdominal ● Assess

Cefuroxime susceptible nsitivity cramps, baseline
infections due to severe assessm
Brand Name Mechanism of Action to group B celecoxi diarrhea, ent
Ceftin ● Binds to streptococci, b, fever, ● Asses
bacterial cell pneumococci, severe for oral
sulfona
Dosage membranes, staphylococci, pruritus, cavity
● Injection, H. influenzae,
mides, angioedem
inhibits cell for
Powder for wall E. coli, aspirin, a, white
Reconstituti synthesis. enterobacter, other bronchosp patches.
on: 750 mg, Klebsiella NSAIDs. asm ● Advise
1.5 g including anaphylaxi the
● Oral acute/chronic s. patient
Suspension: bronchitis, to
125 gonorrhea, continu
mg/5mL, impetigo, e
250 mg/5 early Lyme antibiot
mL disease, otitis ic
● Tablets: 250 media, therapy
mg, 500 mg pharyngitis/to for full
nsillitis, length
Route sinusitis, of
Intravenous, skin/skin treatme
Intramuscular, structure, nt.
Oral UTI,
perioperative
Frequency prophylaxis.
IV, IM: Adults,
Elderly, Children 12
years old and older-
q6h to q8h
12 year old below-
q8h
PO: twice a day
 CLASSIFICATIO CONTRA ADVERSE NURSING
DRUG NAME N/MECHANISM INDICATIONS INDICATIONS REACTION RESPONSIBILITI
OF ACTION ES

Generic Name ● Enzymatic ● Ferrous ● Hypersensi ● Peptic ● Asses for

Ferrous Sulfate Mineral fumarate, tivity to ulcer, nutritional
gluconate, iron salts regiona status and
Brand Name Mechanism of sulfate is a ● Hemochro l dietary
Brisofer, Feosol, Action prevention matosis enteriti history
Hemovit ● Essential and ● Hemolytic s, ● Advice to
component treatment for anemias ulcerati Take
Dosage in iron ve medication
● Adult: formation deficiency colitis, between
65-200 mg of Hgb, Ferric vomitin meals with
daily myoglobin, gluconate is g, orange
enzymes.P the severe juice or
Route romotes treatment of abdomi vitamin C
● Oral effective iron-deficien nal supplemen
erythropoi cy anemia in pain, t
Frequency esis and combination diarrhe ● Inform the
● 65-200 mg transport, with a, patient to
daily utilization erythropoieti dehydr expect
● 30 mg orally of oxygen. n in HD ation, stool color
during It also points hyperv to darken
pregnancy prevents entilati
● 15 mg iron on,
orally deficiency pallor,
during cyanosi
lactation. s,
cardiov
ascular
collaps
e.
 CLASSIFICATIO CONTRA ADVERSE NURSING
DRUG NAME N/MECHANISM INDICATIONS INDICATIONS REACTION RESPONSIBILITI
OF ACTION ES

Generic Name ● Electrolyte ● It plays an ● Hyperse ● Early ● Assess for

Calcium Carbonate replenisher important nsitivity signs of b/p
, antacid, role in to constipat ● Monitors for
Brand Name antihypoca normal calcium ion, sign of
Titralac, Tums lemic, cardiac/ren formulat headache hypercalcem
antihyperk al function, ion , dry ia
Dosage alemic, respiration, mouth, ● Advice the
● 1 g = 400 antihyper blood increased patient to
mg, Tablets: magnesemi coagulation thirst, avoid the use
500 mg,600 c, , cell irritabilit of alcohol,
mg, 1,250 antihyperp membrane y, tobacco, and
mg, 1,500 hosphatem and decrease caffeine
mg ic capillary d
● Tablets permeabilit appetite,
(chewable): Mechanism of y. metallic
500 mg, Action taste,
750mg, ● Antacid, fatigue,
1000 mg dietary weakness
supplemen , and
Route ts depressio
● Oral n

Frequency
● Adults,
Elderly: 2-4
times/day
● Children
older than 4
years old: 3
times/day
● Children
(2-4 yrs
old): 2
times/ day
 CLASSIFICATIO CONTRA ADVERSE NURSING
DRUG NAME N/MECHANISM INDICATIONS INDICATIONS REACTION RESPONSIBILITI
OF ACTION ES

Generic Name ● Vitamin, ● Treatment ● Hyperse ● Allergic ● Suggest to

Folic Acid water of nsitivity hypersen the patient
soluble, megaloblast to folic sitivity to eat food
and ic and acid. occurs rich in folic
Brand Name nutritional macrocytic Anemias rarely acid,
Iberet Folic Acid supplemen anemias when with including
t due to anemia parenter fruits,vegeta
Dosage folate is al form. bles, organ
● Oral: 0.8 deficiency. present And oral meats
mg, 5 mg, Mechanism of Treatment with folic acid ● Advise the
20 mg, Action of anemias vitamin is patient to
● Injection ● It due to b12 nontoxic avoid the use
Solution: 5 stimulates folate deficienc of alcohol
mg/mL production deficiency y and tobacco
● Tablets: 0.4 of in pregnant
mg (OTC), platelets, women.
0.8 (OTC), WBCs in Folate
1 mg folate-defic supplement
iency ation
anemia. during
Route Necessary periconcept
● IM for ual period
● IV formation decreases
● SQ of risk of
● PO co-enzyme neural tube
s in many defects
metabolic
Frequency pathways
● Pregnant/la that is
ctating necessary
women: for
0.8/day erythropoi
● Women of esis
childbearin
g age:
400-800
mcg/day
● Women at
high risk of
family
history of
neural tube
defects: 4
mg/day
 CLASSIFICATIO CONTRA ADVERSE NURSING
DRUG NAME N/MECHANISM INDICATIONS INDICATIONS REACTION RESPONSIBILITI
OF ACTION ES

Generic Name ● Classified ● A ● Hyperse ● Monitor the

Arcoxia as treatment nsitivity ● Feeling patient for
non-steroi for sick b/p
; history
Brand Name dal Osteoarthri (nausea), regularly
of vomiting
Etoricoxib anti-inflam tis (OA), while taking
allergic ● heartbur
matory rheumatoid the
Dosage drugs arthritis type n, medication
● Oral: 30 (NSAIDs). (RA), reaction indigestio ● Arcoxia can
mg, 60 mg, ankylosing s (e.g. n, be
90 mg and Mechanism of spondylitis, broncho uncomfor administere
120 mg. Action and the spasm, table d regardless
● Etoricoxib discomfort acute feeling or of food
Route functions and rhinitis, pain in intake
● Oral by inflammati nasal the ● Assess for
preventing on brought stomach allergic
polysps,
Frequency the action on by acute ● diarrhea
angione
● 60 mg once of the gouty ● swelling
urotic
a day cyclo-oxyg arthritis of the
enase-2
oedema, legs,
(COX-2) or ankles or
enzyme, a urticari feet
naturally a) after ● high
occurring taking blood
molecule. aspirin, pressure
This NSAIDs ● dizziness
enzyme ● headache
aids in the
body's
production
of
prostaglan
dins,
another
type of
molecule.