Placenta Previa

Case Study
Adefuin, Jay
Rovillos, Noemie M.
 TABLE OF CONTENTS
01 02
CLINICAL SCENARIO PATIENT DIAGNOSIS
ADMISSION DEMOGRAPHIC DATA CONDITIONS &
LABORATORY

03 04 05
PATHOPHYSIOLOGY TREATMENT DRUG STUDY
CAUSE AND EFFECT MEDICAL AND SURGICAL MEDICATIONS
 TABLE OF CONTENTS

06 07

NURSING CARE PLAN FDAR

ADPIE FOCUS, DATA, ACTION & RESPONSE

 CLINICAL SCENARIO
On February 26, 2023, the patient named Gemmalyn Ermac, 30y/o from Dayap Calauan,
Laguna was admitted to San Pablo City General Hospital. Prior to admission, the patient
complained of dizziness. The patient also noticed that she was having vaginal spotting.
When the patient was admitted to the hospital, she was diagnosed already with placenta
previa. Furthermore, the fetal ultrasound revealed that the placenta edge appears near the
internal os.
01.
ABOUT THE
PATIENT
Data of the Patient
 DEMOGRAPHIC DATA

Name: Gemmalyn S. Ermac

Age: 30
Gender: Female
Date of Birth: July 28, 1992
Marital Status: Single
FEMALE PATIENT Religion: Catholic
Ethnicity: Filipino
PATIENT PRESENT HISTORY
AOG: 35 weeks

GRAVIDA: 2

PARA: 1

ABORTION 1

LIVING 1
02.
DIAGNOSIS
CONDITIONS & LABORATORY
 PLACENTA PREVIA
ADMITTING DIAGNOSIS

The condition known as placenta previa occurs when

the placenta develops in the lowest region of the uterus
(womb) and covers all or part of the entrance to the
cervix. This can be a concern for pregnant women.
 CLASSIFICATION OF PLACENTA PREVIA

1. Total Previa- the placenta completely covers the internal cervical os.
2. Partial Previa- the placenta covers a part of the internal cervical os.
3. Marginal Previa- the edge of the placenta lies at the margin of the internal cervical os
and may be exposed during dilatation.
4. Low-lying placenta- the placenta is implanted in the lower uterine segment but does not
reach to the internal os of the cervix.
CLASSIFICATION OF PLACENTA PREVIA
 Ultrasound Findings:

● Fetal Number: Single

● Fetal Lie presentation: Cephalic
● Placental Location: Posterior
● Grade: I-II
● Amniotic Fluid: Adequate
● Fetal Movements: Positive
● Cartier Activity: Positive (141 BPM)
● Sex: Male

The placenta edge appears near the internal os

03.
PATHOPHYSIOLOGY

CAUSE AND EFFECT

04.
TREATMENT
MEDICAL AND SURGICAL
 TREATMENT MEDICAL/ SURGICAL
Patient Name: Gemmalyn S. Ermac

Medical Nursing
Indication Rationale
Treatment Considerations

Blood Transfusion Blood loss and People who have major -Monitor vital signs.
symptomatic anemia surgeries, like CS, will Changes in vital signs
get a blood transfusion to imply a harmful
make up for any blood reaction (increase in
loss. And, due to the temp, increase in
patient’s condition, such respiratory rate)
as anemia, she needs a
blood transfusion to
avoid any other
complications.
TREATMENT MEDICAL/ SURGICAL
Patient Name: Gemmalyn S. Ermac

Medical
Nursing Considerations
Treatment

Blood Transfusion -To prevent unwanted consequences, do not combine drugs and
blood transfusion. Do not administer medication during a blood
transfusion. Do not utilize blood transfusion lines to provide
medications intravenously.

-Observe for potential complications. Notify physician.

 TREATMENT MEDICAL/ SURGICAL
Patient Name: Gemmalyn S. Ermac

Surgical Nursing
Indication Rationale
Treatment Considerations

Laceration Suture Torn flesh in the To repair the injured Always assist the
abdominal area flesh in order for it to patient and examine
heal and return to its him or her for
normal condition. discomfort and
bleeding
05.
DRUG STUDY
MEDICATIONS
 Side effects/
Generic- Classification/ Nursing Patient
Adverse
Brand Name Indication Consideration Teaching
Reaction

Ferrous *Oral: Iron-deficiency *CNS: CNS *Check doctor' order to

verify medication
*Explain to the patient the
side effects that may occur
anemia, Iron toxicity, acidosis,
Sulfate- preparation.
Ferosal coma and death *Assess vital signs and *Educate that this drug has
*Prevention and with overdose review the purpose and specified used only.
importance of the drug
treatment of iron
deficiency anemias *GI: GI upset, *Warn patient that stool
*Administer the right may be dark or green and
brought about by the anorexia, nausea, drug, dose and route at the arrange for periodic
illness vomiting, right time to avoid mistake monitoring of Hct and
Hgb levels
*Unlabeled use:
constipation,
diarrhea, dark stool, *Monitor blood studies
supplemental use and confirm that the client *Keep this drug out of
during epoetin therapy temporary staining does have iron deficiency reach of children (may
to ensure proper of teeth anemia cause fetal poisoning)
hematologic response
to epoetin
Generic- Brand Classification/
Name Indication
Cefuroxime *Cephalosporins
Antibiotic/antibacterial
-Ceftin
*Used for the treatment
of many different types
of bacterial infection,
such as bronchitis,
sinusitis, tonsillitis skin
infection, ear infection,
gonorrhea, UTI
Side effects/ Nursing
Patient Teaching
Adverse Reaction Consideration
*CNS: Chills, fever, *Check doctor's order to
avoid mistake.
*Explain to the patient the
side effects that may occur
headache, seizures
*Assess vital signs *Educate that this drug
*GI: Nausea, has specified used only.
Vomiting, diarrhea, *Administer the right drug,
abdominal cramps, dose and route at the right
*Warn patient that stool
time to avoid mistake
elevated liver may be dark or green and
arrange for periodic
enzymes *Determine history of monitoring of Hct and
*EENT: hearing loss hypersensitivity reaction to Hgb levels
*RESD: Dyspnea the medication before
administration
*Keep this drug out of
*Check the label and follow
reach of children (may
the rights to medicate cause fetal poisoning)
* Monitor BUN and
Creatinine clearance
Generic- Brand Classification/ Side effects/ Nursing
Patient Teaching
Name Indication Adverse Reaction Consideration

Oxytocin *Hormone Increase heart *Check doctor's order to

avoid mistake.
*Explain to the
rate, nausea, patient the side
effects that may
*Use for the vomiting, *Assess vita and accurate
record of vital signs. occur.
initiation of increased uterine
improvement of motility *Administer the right drug,
dose and route at the right
*Educate that this
uterine time to avoid mistake drug is specified for
uterine contraction
contractions to *Continuously monitor and nothing else.
achieve early contraction, fetal
maternal heart rate, and
and

vaginal delivery maternal blood pressure and

ECG as well

*Check the label and follow

the rights to medicate
 Side effects/
Generic- Classification/ Nursing
Adverse Consideration Patient Teaching
Brand Name Indication
Reaction

Midazolam *Anti-anxiety *Decreased *Verify client's identity *Explain to the patient the
and check doctor's order to
agents, Respiratory rate, avoid mistake side effects that may
sedative/hypnotics, Tenderness at IM or occur.
and anticonvulsant. IV site, Oxygen *Assess vital and accurate
record of vital signs.
desaturation, *Educate that this drug
*Preprocedural Hypotension,
sedation. Aid in the nausea, vomiting,
*Administer the right has specified used.
drug, dose and route at the
induction of headache, and right time to avoid mistake
anesthesia and as coughing *Encourage the client to
part of balanced *Assess level of turn, cough, and breathe
consciousness
anesthesia. deeply to prevent lung
*Check the label and problem
follow the rights to
medicate
 Side effects/
Generic- Brand Classification/ Nursing
Adverse Patient Teaching
Name Indication Consideration
Reaction

Ephedrine Sulfate *Bronchodilator *CNS: Headache, *Verify client's identity *Explain to the patient
and check doctor's order the side effects that
Sympathomimetic insomnia, sweating, to avoid mistake
Nervousness, may occur and report
Vasopressor;
vertigo Weakness, immediately; chest
Adrenergic *Assess vital and
pain, elevate heart
dizziness, accurate record of vital
Confusion. signs. rate, wheezing, chest
*Stimulation of tightness, and
CNS to combat *CARDIOVASCU *Administer the right irregular heartbeat.
narcolepsy and LAR-Palpitation,
drug, dose and route at
the right time to avoid *Educate that this
depressive States tachycardia, mistake
drug has specified
precordial pain, used only.
arrhythmias, *Assess level of
hypertension consciousness

*Check the label and

follow the rights to
medicate
 Side effects/
Generic- Classification/ Nursing Patient
Adverse
Brand Name Indication Consideration Teaching
Reaction

Sensorcaine *Epidural local *CNS: Seizure, *Monitor blood pressure,

heart rate, and respiratory
*Explain to the
anesthesia dizziness, rate continuously while patient the side
Weakness, receiving this medication
effects that may
*Local or regional restlessness, occur.
*Assess for systemic
anesthesia or anxiety toxicity; numbness,
analgesia for ringing in ear, metallic
surgical, Obstetric *CARDIOVASCU taste, dizziness, blurred *Educate that
or diagnosis LAR: collapse,
Vission, tremors, Slow this drug has
speech, seizures.
procedures decreased blood specified used
pressure, *Admisnister the right only.
drug, dose and route at the
bradycardia. right time to avoid mistake
 Side effects/
Generic- Classification/ Nursing
Adverse Consideration Patient Teaching
Brand Name Indication
Reaction

*Mephyton/ *Hemostatics; *Pain, soreness, *Monitor for side effect; pain *Explain to the
erythema at the injection site,
Phytomena- Vitamins, fats swelling at IM skin rash, urticaria, patient the side
Soluble, antidote injection site, facial hypersensitivity reaction,
dione hyperbilirubinemia(neonate)
effects that may
*Vit. K flushing, altered occur
*Prevention & taste, dizziness,
treatment of *Monitor for any bleeding. May
rapid heart beats, be seen as generalized
hemorrhagic states in
sweating, SOB, ecchymoses or bleeding from *Educate that this
neonate.
hyperbilirubinemia(
umbilical cord, circumcision drug has specified
site, nos3 or GI tract
neonate) used only.
*Antidote for
hemorrhage induced *Administer the right drug,
by oral anticoagulant,
dose and route at the right time
to avoid mistake
*Apply pressure to
hypoprothrombinemic the injection site to
states due to Vit.k *Provide comfort during and prevent bleeding
deficiency. after administration
 Side effects/
Generic- Classification/ Nursing
Adverse Patient Teaching
Brand Name Indication Consideration
Reaction
*Erythromycin *Antibacterial *Minor eye *Cleanse the infant's *Cleanse the infant's eyes as
*Ilotycin irritation, stinging, eyes as needed before needed before application
*Treatment of application
Ophthalmic superficial ocular
burning, redness,
*Do not touch the tip of the
*Romycin infection caused by temporary blurred *Do not touch the tip of tube to any part of the eye
*Ophthalmic susceptible strain of vision, and the tube to any part of
microorganism; hypersensitivity the eye *Administer from the inner
Prophylaxis of reaction canthus to outer canthus.
ophthalmia neonatorum *Administer from the *Explain to the patient
caused by Gonorrhea inner canthus to outer the side effects that may
canthus. occur
*Explain to the
patient the side effects *Educate that this drug has
that may occur specified used only.

*Educate that this drug

has specified used
only.
 Side effects/
Generic- Classification/ Nursing
Adverse Patient Teaching
Brand Name Indication Consideration
Reaction
*Tramadol Hcl *Opiods Analgesic *CNS: Dizziness, *Check doctor' order, *Explain to the patient the
*Ryzolt, Ultram weakness, assess to side effects that may occur
*Centrally-acting hypersensitivity to
analgesic
headache,
tramadol, pregnancy, *Educate that this drug has
drowsiness lactation, seizure. specified used only.
*Relief of moderate to
moderately severe pain *CV: Orthostatic *Assess vital signs and *Advice to take it with food
Bind to receptors. Hypotension review the purpose with milk to prevent GI upset
Inhibits reuptake of and importance of the
serotonin and drug *Advice to take diet rich in
norepinephrine in the
*GI: Nausea,
K+, Report if side effects
CSN vomiting, Anorexia, *Administer the right occurs.
diarrhea drug, dose and route
at the right time to
avoid mistake
 Side effects/
Generic- Classification/ Nursing
Adverse Patient Teaching
Brand Name Indication Consideration
Reaction
*Paracetamol *Analgesic (Non- *CNS: headache *Check doctor' order to *Explain to the patient the
*Biogesic opiods) antipyretic verify medication side effects that may occur

*Reduces fever by
*CV: Chest pain,
*Assess vital signs and *Educate that this drug has
acting directly on the myocardial damage review the purpose specified used only.
hypothalamic heat when ingested daily and importance of the
regulating center to in several weeks drug. *Advice to take it with food
cause vasodilation and milk to prevent GI upset,
which helps dissipate *GI: Hepatic *Administer the right avoid alcohol
heat drug, dose and route
toxicity and failure,
at the right time to *Report paleness, weakness
*Substitute for aspirin Jaundice avoid mistake. and heartbeat skips.
in upper GI disease,
bleeding disorders *GU: Acute renal *Give drug with food if *Take the medication exactly
clients in anticoagulant failure, renal GI upset occurs. as prescribed
therapy and gouty tubular necrosis
arthritis
Generic- Classification/ Side effects/ Nursing
Patient Teaching
Brand Name Indication Adverse Reaction Consideration

*Celecoxib *Analgesic(non- *CNS: headache, *Check doctor' order to *Explain to the patient the
*Celebrex opiods), anti- dizziness, insomnia, verify medication side effects that may occur.
inflammatory,
antirheumatic
somnolence (severe
*Assess vital signs and *Educate that this drug has
*Acute and long term drowsiness), review the purpose specified used only.
treatment of sign and insomnia, fatigue, and importance of the
symptoms of tiredness, tinnitus drug *Advice to take it with food
rheumatoid arthritis & milk to prevent GI upset,
osteoarthritis, *CV: myocardial *Administer the right avoid alcohol
drug, dose and route
infarction, CVA
*Celecoxib is at the right time to *Instruct discontinuation of
prescribed to avoid mistake medication if adverse effect
postpartum mothers to *GI: Nausea, occurs
relieve and alleviate abdominal pain, *Administer drug with
acute pain dyspepsia, flatulence, food or after meals if
GI bleeding GI upset occurs
06.
NURSING CARE PLAN

ASSESSMENT, DIAGNOSIS, PLANNING, IMPLEMENTATION,

EVALUATION.
 PLANNING/
ASSESSMENT DIAGNOSIS IMPLEMENTATION RATIONALE EVALUATION
GOAL

Subjective Data: Acute pain STG (short Independent: *To have a Goal met after 3
related to term goal) good hours of nursing
"Kumikirot yung
tahi sakin" as
disruption of *Established nurse-client intervention, the
verbalized by the skin and After 2-3 hours rapport relationship patient
patient tissue of intervention, *To establish a verbalized the
secondary to the patient will *Monitored vital baseline data pain decreased
cesarean verbalize signs from 7/10 to 3/10
Objective Data: section (CS) decrease in *Calm as evidence by (-)
*Afebrile pain from 7/10 *Assessed environment facial grimace, (-)
to 3/10 severity of pain helps to guarding
*PS- 7/10 decrease the behavior.
*Provide anxiety of the Frequent small
*Teary eye comfortable client talks with
*Pale skin
environment significant other
turned on the fan,
changed bed linen
*Pale skin *Instructed the *To establish a
patient to do deep baseline data
*(+) guarding
behavior
breathing and for comparison
coughing exercise in making
*(+) facial grimace evaluation
Collab:
V/s taken as *Administered *For pulmonary
follow: medication as per ventilation,
BP-110/70 doctor's order especially
TEMP-36.1 when
PR-72 exercising, and
RR-20 to relieve
O² Sat-98% stress and
promote
relaxation

*To improve
the health
status of our
client
07.
FDAR
FOCUS, DATA, ACTION & RESPONSE
 CLINICAL SCENARIO
On February 26, 2023, the patient named Gemmalyn Ermac, 30y/o from Dayap Calauan,
Laguna was admitted to San Pablo City General Hospital. Prior to admission, the patient
complained of dizziness. The patient also noticed that she was having vaginal spotting.
When the patient was admitted to the hospital, she was diagnosed already with placenta
previa. Furthermore, the fetal ultrasound revealed that the placenta edge appears near the
internal os.
 FOCUS DATA ACTION RESPONSE

Admission: for CS ● V/S taken & Recorded ● Endorsed to OR nurse

● AOG 37 weeks ● Maintained therapeutic ● Patient in fair
● Conscious & Coherent environment. condition.
● Afebrile ● Provide IVF starter D5LN 1L
● FHT 146bpm x 8 as ordered.
● FH 30cm
● Signed & secured
● For Cs under Dr. Castillo

Vital Signs:
● Blood Pressure: 110/70
mmHg
● Pulse Rate: 88 bpm
● Temperature: 36.2 °C
● Respiratory Rate: 22 bpm
 FOCUS DATA ACTION RESPONSE

Intraoperative ● Hooked to O2 inn & Cardiac ● The patient

Care ● Conscious & Coherent Monitor expected to have
● Afebrile ● IV checked & regulated
● FHT 140bpm
pain in the
● Initial counting of instruments &
● Vaginal Bleeding & sponges done laceration suture
Uterine contractions ● Foley catheter inserted due to having a
● Not in any distress aseptically. cesarean section.
● Sterile drapes placed.
Vital Signs: ● Anesthesia inducted by Dr.
● Blood Pressure: 100/70 Bondad at 10:40am
mmHg ● Operation started by Dr. Castillo
● Pulse Rate: 63 bpm at 10:50am
● Temperature: 36.4 °C ● Baby’s out at 10:56am
● Respiratory Rate: 21 bpm ● Placenta out at 10:57am
● Abdominal incision sutured by
layers
● Final Counting of instruments &
sponges done
● Operation ended at 12nn
 FOCUS DATA ACTION RESPONSE

Post op care ● S/F RT PCR

● Afebrile ● V/S taken & recorded ● After six to eight
● Conscious & coherent ● IVF checked & regulated
hours of bed rest, the
● Due meds given
● Maintained therapeutic patient should start
Vital Sign: to feel better
● BP: 110/70 mmhg environment.
● Kept safe.
● T: 36.7 C
● Needs attended.
● PR: 80 bpm
● RR: 20 bpm
THANKS
 GROUP 1- PLACENTA PREVIA

ADEFUIN, JAY ROVILLOS, NOEMIE M.

“AMEN” “AYOKO NA”