CASE STUDY

I. Case study on: Multi Gravida with Placenta Previa with 27 weeks of Gestation

A. Assessment
1.Patient’s profile

Name: Eddrelei DR. Mendoza Age: 35 years old

Address: Lastimosa Drive Lunzuran Zamboanga City Gender: Female
Nationality: Filipino
Occupation: Housewife (Income)Estimate per week: None

Family Members::
Edwardo A. Mendoza Male High School Glass Installer Per week: 4,500
Per month:18,000
Eddrelei DR. Mendoza Female Elementary Housewife None

Mikhaela DR. . Female Nursery Student None

Mendoza
Marisel DR. Mendoza Female None Newborn None

2. Physical Assessment (Cephalocaudal)

Physical Examination for a 35-year-old Woman with Multi Gravida with Placenta previa:

Head:
- Eyes: No discharge, no infection, no jaundice, eyes clean, conjunctiva pinkish
- Ears: Normal shape, no swollen glands, no valve discharge
- Nose: Clear, no septal deformity, no crusts and discharge no cold.
- Neck: No swelling, no palpable nodes, no deformity, no pain in the neck.
- Mouth: Tounge moist, lips dry, no artificial dentures, teeth clean and healthy, no congenital
defect i.e. cleft lip or cleft palate

Chest: Symmetric shape and size of the chest, breasts well developed, nipples normal, no scar, no
palpable lymph glands, Chlostrum present.

-Upper Extremities: symmetrical and no deformity, no scar, no extra digits, nails pink and clean,
skin colour normal, extremities warm, edema not present
Abdomen:
-Inspection: Ovoid shape, normal size, scar of previous surgery present, linea nigra present, no
any visible dilated veins
-Palpation: There is normal growth of fetus and fundal height according to gestational age.
-Auscultation: On auscultation FHS not found.

Genitalia:
- No lesions or swelling noted.

Lower Extremities: symmetrical, no deformity, no varicose veins, no edema, no extra digits, no

pain in calf muscles, Homans sign absent.

Back : No spinal or any deformity.

3. Gordon’s Functional Health Pattern

: Gordon's 11 Functional Health Patterns Assessment - 35-Year-Old Woman with Placenta previa

Health Perception-Health Management:

The client, a 35-year-old Woman, presents with Multi Gravida with Placenta previa with 27
weeks of Gestation. She acknowledges the severe bleeding on her 2nd trimester and the
importance of adhering to prescribed treatments, including medications and follow-up
appointments.

Nutritional-Metabolic Pattern:
The client reports a casual dietary pattern of vegetarian and non vegetarian meals; usually 3
times during pregnancy. No denial to food and appetite.

Elimination Pattern:
The client reports normal micturation and regular bowel habits.

Activity-Exercise Pattern:
She is interested in household works and performing daily activities.

Sleep-Rest Pattern:
The client reports disrupted sleep patterns characterised by frequent waking during the night due
to her pregnancy. She expresses frustration but understands the importance of rest for her
recovery.

Cognitive-Perceptual Pattern:
The client demonstrates intact cognitive function and maintains awareness of his surroundings.

Self-Perception-Self-Concept Pattern:
The client expresses feelings of frustration and anxiety but maintains a positive outlook. She
seeks reassurance from healthcare providers and family members to cope and understand the
situation well.

Roles-Relationships Pattern:
The client describes supportive relationships with family members who assist her with daily
tasks and provide emotional support. She expresses gratitude for their involvement in his care.

Sexuality-Reproductive Pattern:
The client reports no current concerns regarding sexual function or reproductive health. She
expresses a willingness to discuss any related issues with healthcare providers.

Coping-Stress Tolerance Pattern:

The client utilizes various coping strategies, including relaxation techniques to avoid stress
during pregnancy

Value-Belief Pattern:
The client values her health and understands the significance of adhering to treatment
recommendations. She expresses a sense of responsibility to prioritize his well-being and regain
his strength.

4. PROBLEMS IDENTIFIED
1. Severe Bleeding
2. Early Birth

5. PATHOPHYSIOLOGY

Placental implantation is initiated by the embryo (embryonic plate) adhering in the lower
(caudal) uterus. with the placental attachment and growth ,the developing placenta may
cover the cervical os. However it is thought that a defective decidual devascularisation
occurs over the cerix,possibly secondary to inflammatory or atrophic changes. As such
placenta undergone atrophic changes could persist as a vasa previa. A leading cause of
third trimester bleeding/haemorrhage, placenta previa present classically, a painless
bleeding. Bleeding is thought to occur in association with the development of the lower
uterine segment in third trimester. Placental attachment is disrupted at this area gradually
in the preparation of the onset of labour. When this occurs at implantation site as the
uterus is unable to contract adequately and stop thw flow of blood from the open vessels.
Thrombin release from the bleeding site promotes uterine contraction and a vicious circle
of bleeding,uterine contraction placental separation and bleeding persists.

• Classically, the clinical presentation of placenta previa is painless vaginal bleeding in

the second or third trimester. In contrast, placental abruption, classically presents with
painful vaginal bleeding.
B. PLANNING

1. NURSING CARE PLAN

ASSESSMEN DIAGNOSIS PLANNIN INTERVENTIO RATIONALE EVALUATIO
T G N N

Subjective: `Deficient After 8 hrs. .-Monitor Vital .-To obtain After 8 hrs of
Fluid Volume of nursing Signs baseline data nursing
‘’ Nakararanas related to intervention -Assess color, -Provides intervention:
po ako active blood ; odor, information The patient
ng pagdurugo loss Patient will consistency and about active will maintain
pero hindi secondary to maintain amount bleeding fluid
naman ako disrupted fluid of vaginal versus old blood, volume at a
nakararamdam placental volume at a bleeding; tissue functional
ng kahit implantation functional weigh pads loss and degree level possibly
na anong as level -Assess hourly of blood evidenced
sakit’’ as manifested possibly intake loss by adequate
verbalized by by bleeding evidenced and output. -Provides urinary
the episodes, by adequate -Assess baseline information output and
patient. abdomen soft urinary data about maternal stable vital
when output and and note and fetal signs.
Objective: palpated, stable vital changes. physiologic
body signs. Monitor FHR. compensation to
Vital signs weakness, - Assess SaO2, blood
taken are as low blood skin loss
follows: pressure, color, temp, -Assessment
BP- 90/70 increased moisture, provides
T-36.8 heart rate, turgor, capillary information
RR-10 bpm decreased refill about
PR-90 respiratory - Provide possible
beats/min. rate, fetal supplemental infection,
-Bleeding heart rate of O2 as ordered via placenta previa
episodes less than facemask or or
-Abdomen soft normal (120- nasal cannula abruption.
when 160 bpm), 10-12 L/min. Warm, moist,
palpated decreased - Initiate IV bloody
-Manifests urine output, fluids as environment is
body increased ordered ideal for growth
weakness urine - Position Pt. in of
-Low blood concentration supine microorganisms.
pressure , pale. with hips -Assessment
-Increased elevated if provides
heart rate ordered or left information
-Decreased lateral about blood
respiratory position. vol., O2
rate -Monitor lab. saturation and
-Fetal heart Work as peripheral
rate less obtained: Hgb & perfusion
than normal Hct, Rh - Intervention
(120-160 and type, cross increases
bpm) match available O2 to
-Decreased for 2 units RBCs, saturatedecrease
urine output urinalysis, etc. d hemoglobin
-Increased Scheduled for -For replacement
urine ultrasound as of fluid
concentration ordered. vol. loss
- Pale - Position
decreases
pressure on
placenta
and cervical os.
Left
lateral position
improves
placental
perfusion
-Lab Work
provides
information
about
degree of blood
loss;
prepares for
possible
transfusion.
Ultrasound
provides info
about the
cause of
bleeding