COLLEGE OF NURSING

Foundation University
Dr. Miciano Road, Taclobo, Dumaguete City 6200

CASE STUDY OF A POSTSURGERY, CESAREAN SECTION CLIENT WITH PLACENTA PREVIA

In Partial Fulfilment of the Requirements for the

Degree of Bachelor of Science in Nursing

NUR201B

SUBMITTED TO:

Kissie L. Fua, RN

SUBMITTED BY:

LEVEL II B2 SUBGROUP A
Amigo, Shyrkeene
Armentano, Loryjen
Buenavista, Josef Jesvir
Carsano, Hanna Maica
De Jesus Sheena Summer
Lucero, Sidney
Padernal, Hannah Jhane
Sardane, Nizpha Solis, Lalaine

DATE OF SUBMISSION:

January 9, 2023

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 TABLE OF CONTENTS
I. FOUNDATION UNIVERSITY VISION, MISSION AND LIFE PURPOSE 4
II. CENTRAL OBJECTIVES AND SPECIFIC OBJECTIVES 5
III. ACKNOWLEDGEMENT 6
IV. INTRODUCTION 7
V. DEMOGRAPHIC PROFILE 8
A. IDENTIFICATION DATA 8
VI. DEVELOPMENTAL TASKS 9
VII. ANATOMY AND PHYSIOLOGY 11
VIII. REVIEW OF RELATED LITERATURE 14
IX. MEDICAL MANAGEMENT 17
A. LABORATORY EXAMS AND CORRELATION 17
B. TREATMENT MODALITIES 21
C. DRUG STUDY 22
D. CONCEPT MAP 28
X. NURSING MANAGEMENT 32
A. NURSING HISTORY 32
1. FAMILY HISTORY WITH GENOGRAM 33
2. PSYCHOSOCIAL HISTORY 33
3. ENVIRONMENTAL HISTORY 33
4. SPIRITUAL HISTORY 33

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 B. PHYSICAL ASSESSMENT 34
C. NURSING THEORY 36
D. GORDON’S FUNCTIONAL HEALTH PATTERN 36
E. SUMMARY OF NURSING DIAGNOSES 40
F. NURSING CARE PLAN 41
XII. CONCLUSION 46
XIII. REFERENCES 46

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 I. FOUNDATION UNIVERSITY VISION, MISSION AND LIFE PURPOSE

VISION

Foundation University envision itself as a dynamic, progressive environment that cultivates effective learning, generates creative ideas,
responds to societal needs and offers equal opportunity for all.

MISSION

To enhance and promote a climate of excellence relevant to challenges of the time, where individuals are committed to the pursuit of new
knowledge and life-long learning in service of society.

LIFE PURPOSE

To educate and develop individuals to become productive, creative, useful and responsible citizens of the society.

CORE VALUES

● Excellence

● Commitment

● Integrity

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 ● Service

II. CENTRAL OBJECTIVES AND SPECIFIC OBJECTIVES

Central Objectives

This study aims to determine the overall health of the patient and to identify the specific needs that patient requires. This case study also seeks data of the

said patient to conceptualize a care plan that promotes health and wellness through utilizing the nursing skills that can be applied in this study. Through

this case study, we will be able to understand different medical conditions that will enable us to become more competent and insightful nurses by

acknowledging specific information that will broaden our perception and intelligence.

Specific Objectives

 Gather important data of the patient without invading their privacy.

 Identify the type of nursing intervention that the patient needs.

 Understand the purpose of this case study.

 Organize the information being collected accordingly.

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  Provide comfort and assurance to the patient with regards to confidentiality.

 Construct an appropriate nursing plan exclusive for that specific patient.

 Recognize concerns of the patients and suggest solution to them.

 Create a meaningful and successful case presentation.

III. Acknowledgment

We would like to express our heartfelt gratitude to a lot of people and institutions, but we would like to start by thanking the Lord God Almighty for

without Him, all of these won’t be possible. We would also like to thank our clinical instructor, Ma’am Kissie T. Largo and Foundation University College of

Nursing for handing us a lot of opportunities and teachings for the OB rotation throughout numerous consultations. We would also love to expand our

gratitude for every person who had been part of guiding us directly and indirectly in making this very special case book. To our families and friends, thank

you for always being there to support and cheer for us, for always believing in us and encouraging us to do better. To our beloved classmates, thank you

for suggesting ideas and helping us through the difficult process of making this case book. And lastly, to our group mates who diligently worked hard to

complete this case book, for all the sleepless nights, cups of coffees as well as all the fun we had at the OB rotation.

With this case book comes the hard work, dedication, and commitment we put into it. But still, this won’t be what it is, if not for everyone

mentioned. From the bottom of our hearts, thank you.

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 GODBLESS!

IV. INTRODUCTION
The complication that caused the greatest number of cesarean sections is placenta previa. None of the mothers died; but, out of 48 infants, 18 or 37.5 per
cent either were stillborn (9) or died after birth. Sixteen infants or 88.88 per cent were premature. Placenta previa refers to placenta which is implanted
partially or completely over the lower uterine segment (over and adjacent to the internal os) after 20 weeks of pregnancy. “Previa” comes from two words:
“pre”(or “prae”) meaning before, and “via” meaning way. “Previa” usually refers to anything obstructing the presenting part. Placenta previa therefore
means “placenta in the way, before the baby’s presenting part”.

Based on proximity of the placental tissue to the internal cervical os, four types of placenta previa have been traditionally described. Type I or low lying
placenta in which the placental edge is within 2 cm of but not reaching the internal cervical os. Type II or marginal placenta where the placental edge
reaches the margin of but does not cover the internal cervical os, type III or partial or incomplete when the placental edge partially covers the internal
cervical os (especially when closed but not entirely when fully dilated), and type IV or complete, when the placenta totally covers the internal cervical os
including during full cervical dilatation. The National Institutes of Health sponsored Fetal Imaging Workshop recommended two categories of placenta
previa: placenta previa, when the internal os is covered partially or completely by placenta or low-lying placenta, when the placenta is implanted in the
lower segment but the placental edge does not reach or cover the internal os and remains within 2 cm of the cervical os.

The overall prevalence of placenta previa is estimated as 5.2 per 1000 pregnancies, with marked regional variation. The prevalence is highest among Asian
studies (12.2 per 1000 pregnancies) and lower in European (3.6 per 1000 pregnancies), North American (2.9 per 1000 pregnancies) and Sub-Saharan
African (2.7 per 1000 pregnancies) studies. The risks of placenta previa increases 1.5–5-fold following cesarean delivery and with increasing numbers of
cesarean deliveries, at 1% after one cesarean delivery, 2.8% after three cesarean deliveries, and 3.7% after five cesarean deliveries. Placenta previa
following prior cesarean sections has been associated with high and increasing risk of placenta accreta syndromes.

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V.DEMOGRAPHIC DATA
Patients Name: CC Date of Admission: November 26, 2022
Date of Birth: October 7, 1986 Attending Physician: Dr. Emerald Bulado
Address: Talungon, Bais City
Age: 36 years old
Sex: Female
Status: Married
Nationality: Filipino
Religion: Roman Catholic
Occupation: Account Supervisor
Weight: 75kg
Height: 155cm
Ward: Obstetrics and Gynecology
Case No: 129632
Diagnosis: Placenta Previa

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9
 VI. DEVELOPMENTAL TASKS

DEVELOPMENTAL TASK DEFINITION CORRELATION

PSYCHOSOCIAL DEVELOPMENT Intimacy vs Isolation: Patient C.B.C claims that she is contented and
happy living with her husband and for what she
(Erik Erikson) Intimacy versus isolation is the sixth stage of achieved. The patient and her husband have
Erik Erikson's theory of psychosocial been living for 11 years as an extended family.
development. This stage occurs between the She also relish intimate moments with her
ages of 19 and 40, during the early stages of husband.
adulthood.

This stage of life is the desire to form

affectionate and loving relationships with
others. Those who succeed at this stage can
form deep relationships and social connections
while struggling at this stage can lead to
feelings of isolation and loneliness.

PSYCHOSEXUAL DEVELOPMENT Genital stage:
(Sigmund Freud) The final stage of psychosexual development is
the genital stage. Freud believed that the
genital stage begins during puberty and
continues throughout a person's life. The libido
becomes active again with the start of puberty.
The person forms a strong sexual attraction to
the opposite sex. While the earlier stages focus
on individual needs; during this stage, interest
Patient C.B.C. has been married for 11 (eleven)
years. She claims that she is sexually active
and thus often feels a sexual desire. She also
claimed that she is being cared for and has
developed a loving and lifelong relationship
with her husband.

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 in the welfare of everyone else grows. The goal
of this stage is to obtain balance in all life
aspects.

COGNITIVE DEVELOPMENT Formal Operational Stage: Patient C.B.C can easily comprehend and
accurately answered all the questions in a
(Jean Piaget) The fourth and final stage of Jean Piaget's respectful manner. She claims that important
theory of cognitive development is the formal decision is easy to make and that she is not a
operational stage. It starts around the age of forgetful person.
12 and lasts until adulthood. Thinking is
considerably more refined and advanced at this
stage of development. Individuals can think
about abstract and theoretical concepts and
utilize logic to solve problems in alternative
ways. During this stage, skills such as analytical
thought, deductive reasoning, and systematic
planning emerge.

MORAL DEVELOPMENT Level 2 Conventional morality Stage 4:
(Lawrence Kohlberg) Conventional morality is defined as accepting
social rules and influencing our perception of
what is good and moral. At the conventional
level, we began to embody the moral standards
of respected adult role models. At stage four,
the individual recognizes the significance of
social norms or laws and desires to be a good
part of the group or society.
Patient C.B.C is conscious and acknowledges
the importance of social norms to be a good
member of the society. She focused on
ensuring that the societal norms are maintained
and respects authority by following rules and
doing its duty.

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 VII. ANATOMY AND PHYSIOLOGY

The Female Reproductive System is what?

- The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and
vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the
endometrium. The female reproductive system is a group of organs that work together to enable
reproduction, pregnancy, and childbirth. It also produces female sex hormones, including oestrogen and
progesterone.

What does the Female reproductive system do?

Its functions include:

- producing gametes called eggs, which can potentially be fertilized by sperm.

- secreting sex hormones (such as oestrogen and progesterone).

- providing an environment for a fertilized egg to develop during pregnancy.

-gestating a fetus if fertilization occurs.

- facilitating labor and childbirth.

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What are the parts of the Female Reproductive system?

The organs of the female reproductive system are found both inside and outside of the female body. The organs inside the body are in the pelvis, which is
the lowest part of the body cavity above the legs.

The internal female reproductive organs include:

• Vagina - the area between the lower part of the womb (the cervix) and the outside of the body. The vagina receives the penis during sexual
intercourse and is a passageway for childbirth.
• Womb (uterus) - a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix, which is the
lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby.
A channel through the cervix allows sperm to enter and menstrual blood to exit.
• Ovaries - small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs (ova - an ovum is one egg, ova means
multiple eggs.) The ovaries also produce the main female sex hormones which are released into the bloodstream.
• Uterine (Fallopian) tubes - narrow tubes that are attached to the upper part of the uterus. They serve as tunnels for the ova to travel from the
ovaries to the uterus. The fertilisation of an egg by a sperm (conception) normally occurs in the uterine tubes. The fertilised egg then moves to the
uterus, where it implants into the lining of the uterine wall.

OVULATION AND FERTILIZATION

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The outside (external) structures of the female reproductive system are grouped together in an area called the vulva. They are located just outside the
opening of the vagina. This includes structures such as the labia, the clitoris and a number of
glands. The breasts can also be considered part of the female reproductive system and are located on the
chest.

The vulva consists of:

 The labia - skin flaps or folds on either side of the opening of the vagina. There are two layers
of these skin folds. The outer ones are called the labia majora and are covered with pubic hair
after puberty. The inner folds do not have hair and are called the labia minora.
 The mons pubis - the fatty bulge above the labia which is covered with hair after puberty.
 The vaginal opening (meatus) - the entrance to the vagina.
 The urethral opening (meatus) - the end of the tube which carries urine from the bladder to the
outside (urethra).
 The clitoris - a lump of tissue at the top of the labia. This becomes full of blood during sexual
excitement (like the penis in the man but much smaller). The clitoris is very sensitive and is the
main source of female sexual pleasure.
 The Bartholin's glands (or vestibular glands) - glands on either side of the opening of the
vagina. These produce a sticky substance to moisten (lubricate) the vagina for sexual
intercourse.
 Skene’s glands: These glands are located in the vagina near the urethra. They may be part of the G-spot, and play a role in sexual arousal.

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 VIII. REVIEW OF RELATED LITERATURE

Placenta previa is the complete or partial covering of the internal os of the cervix with the placenta. It is a major risk factor for postpartum

hemorrhage and can lead to morbidity and mortality of the mother and neonate. This situation prevents a safe vaginal delivery and requires the delivery of

the neonate to be via cesarean delivery. Most cases are diagnosed early on in pregnancy via sonography and others may present to the emergency room

with painless vaginal bleeding in the second or third trimester of pregnancy. The presence of placenta previa can also increase a woman's risk for placenta

accreta spectrum (PAS). This spectrum of conditions includes placenta accreta, increta, and percreta. This activity reviews the evaluation and management

of patients with placenta previa. It also highlights the role of an interprofessional team in managing patients with this condition in order to improve

outcomes for mother and fetus. The underlying cause of placenta previa is unknown. There is, however, an association between endometrial damage and

uterine scarring. The risk factors that correlate with placenta previa are advanced maternal age, multiparity, smoking, cocaine use, prior suction, and

curettage, assisted reproductive technology, history of cesarean section(s), and prior placenta previa. The implantation of a zygote (fertilized egg) requires

an environment rich in oxygen and collagen. The outer layer of the dividing zygote, blastocyst, is made up of trophoblast cells which develops into the

placenta and fetal membranes. The trophoblast adheres to the decidua basalis of the endometrium, forming a normal pregnancy. Prior uterine scars

provide an environment that is rich in oxygen and collagen. The trophoblast can adhere to the uterine scar leading to the placenta covering the cervical os

or the placenta invading the walls of the myometrium. Placenta previa affects 0.3% to 2% of pregnancies in the third trimester and has become more

evident secondary to the increasing rates of cesarean sections (Bagga & Sze, 2022)

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 An analysis of the cesarean sections and hysterectomies in the obstetrical department of the Philippine General Hospital during the two years

following liberation is presented. The incidence of cesarean section among 3,749 viable births is 123 cases or 3.28 per cent. The complication that caused

the greatest number of cesarean sections is placenta previa. None of the mothers died; but, out of 48 infants, 18 or 37.5 per cent either were stillborn (9)

or died after birth. Sixteen infants or 88.88 per cent were premature. Dystocia, because of disproportion or malpresentation, was the next outstanding

indication for cesarean section. There was no maternal mortality; but 3 out of 36 infants died, and 2 were stillborn. Two of the infant deaths were caused

by hydrocephalus which were not diagnosed before the operation. One infant died of bronchopneumonia. Of the two stillbirths, one was a case of

anencephalus with a large body, and the other was a severed after-coming head which could not be extracted below. The corrected fetal mortality of this

complication is 1 death or 2.76 per cent. Cesarean section was performed in 7 cases of severe preeclampsia that failed to improve with conservative

treatment, and in 91 cases of severe eclampsia where the fetus was alive, and the cervix was either closed or dilated 1-2 cm. The maternal mortality of

preeclampsia was 14.28 per cent, and that of eclampsia 22.22 per cent. We agree with those who believe that the best treatment for eclampsia, next to

prevention, is the conservative treatment. Traumatic rupture of the uterus was caused by neglected transverse presentation in 41.5 per cent, and by

pituitrin and salag or by pituitrin alone in 33.33 per cent. The high incidence of these causes calls for greater attention to, and proper management of,

malpresentations and fetopelvic disproportion; and for more efficient instruction to those dealing in midwifery on the danger, limitation, and

contraindications of pituitrin and salag. Rupture of the uterus through the cesarean section scar has been found in 4 cases (2.5 per cent), all of which were

of the classical type. Because of the fibrotic condition of the scar and its lessened blood supply, the morbidity of such a type of rupture is relatively lower

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than when the rupture occurs in a nonheparinized uterus. Though all the babies were stillborn, all the mothers recovered, whereas from the traumatic

rupture the maternal mortality was 41.66 per cent. The relative morbidity of the mothers exposed to infection operated on by extraperitoneal cesarean

section and those operated on by laparotrachelotomy in conjunction with penicillin and the sulfa drugs is discussed. From 15 to 30 years dystocia was the

most frequent indication for cesarean section, its incidence being 30%. But, after 31 years, placenta previa was the most frequent complication, its

incidence being 46.87 per cent. Beginning from Para II to Para V, placenta previa was the highest indication for cesarean section, its incidence being 36.8

per cent. But from Para VI onwards, the incidence of placenta previa as indication for cesarean section is as high as 66.66 per cent. (Villanueva, 1947)

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 IX. MEDICAL MANAGEMENT

A. LABORATORY EXAMS AND CORRELATION Glucose: Negative

Urinalysis

Date: November 26, 2022

Physical Examination

Color: yellow

Transparency: Turbid Microscopic Examination:

Chemical Examination Pus Cells: 4-5/hpf

Leucocyte: Trace RBC: 2-3

Nitrate: Negative Epithelial Cells: Abundant

Urobilinogen: Negative Mucous Threads: Few

Protein: Trace Amorphous Materials: Few

pH: 7.0 Bacteria: Moderate

Blood: Negative

Specific Gravity: 1.015 Correlation

Ketones: Trace

Bilirubin: ++

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 Urinalysis

Date: November 29, 2022

Physical Examination

Color: LT. yellow

Transparency: Microscopic Examination:

Chemical Examination Pus Cells: 5/hpf

Leucocyte: negative RBC: <4

Nitrate: Negative Epithelial Cells: Abundant

Urobilinogen: 1.0 Mucous Threads: 18

Protein: negative Amorphous Materials:

pH: 7.5 Bacteria: 265

Blood: Negative

Specific Gravity: 0.010 Correlation

Ketones: negative

Bilirubin: negative

Glucose: Negative

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 ● Complete Blood Count

Date: November 26 and 29, 2022

COMPLETE BLOOD COUNT

EXAMINATION RESULTS NORMAL VALUE UNIT Correlation
White Blood Cell 11/26/22: 8.30 4.0-11.0 10^3/mm 3 Normal
11/29/22: 9.5
Red Blood Cell 11/26/22: 3.61 L 3.8-5.8 X10^6/mm3 Below Normal
11/29/22: 4.1
Hemoglobin 11/26/22: 10.90 L 12-14 g/dL Below Normal
11/29/22: 11.8
Hematocrit 11/26/22:32.20 L 37.0-47.0 g/dL Below Normal
11/29/22: 36.0L
MCV 11/26/22: 89.00 76-96 Um^3 Normal
11/29/22: 88.3
MCH 11/26/22:30.30 27-32 Pg Normal
11/29/22:29.0
MCHC 11/26/22:34.00 30-35 g/dL Normal
11/29/22:32.9
RDW 11/26/22:13.90 11-16 % Normal
11/29/22: 32.9
Platelet Count 11/26/22:125.00 L 150-450 10^3/mm3 Below Normal
11/29/22: 212 L
MPV 11/26/22:9.50 8.0-12.0 Um^3 Normal
Differential Count
Neutrophil 11/26/22: 65.90 40-75 % Normal
11/29/22: 73
Lymphocyte 11/26/22: 25.70 20-45 % Normal
11/29/22: 20

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Monocyte 11/26/22: 5.90 0-10 % Normal
11/29/22: 6
Eosinophil 11/26/22:2.40 0-6 % Normal
11/29/22: 1
Basophil 11/26/22:0.10 0-1 % Normal

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B. TREATMENT MODALITIES

DATE PHYSICIAN’S ORDER RATIONALE

 Provide care to patient
 Admit  For legal purposes
 Secure onset to care  For monitoring the patient
 TPR q4h  A complete blood count (CBC) is a blood test
 LABS: U/A, CBC used to evaluate your overall health and detect
a wide range of disorders, including anemia,
infection and leukemia; U/A, It's used to detect
and manage a wide range of disorders, such as
11-26-22
urinary tract infections, kidney disease and
diabetes. A urinalysis involves checking the
appearance, concentration and content of
urine.
D5LR @ 500cc level  To aid in minimal bleeding and contracted
 IVF to flow with D5LR 1L fundus
 FHT every 30mins  To avoid high risk labor and delivery
complications
11-26-22 ● Due to complaints of pain felt by the patient
● Mefenamic
11-27-22
11-26-22 ● To prevent anemia
● Iron
11-27-22
11-26-22 ● Cefuroxime ● To prevent or treat bacterial infections
11-27-22
11-26-22 ● Prevention or treatment of severe potassium
● KCL tablet
11-27-22 loss

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 C. DRUG STUDY

Generic Name: Mefenamic

Brand Name: Ponstel

Classification: Mefenamic acid is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes
pain, fever, and inflammation.

Actions: Mefenamic acid is a cyclo-oxygenase (Cox-1 and -2) inhibitor and blocks the production of intracellular prostaglandins that are important in
pain and inflammatory pathways. Mefenamic acid has analgesic as well as antipyretic and anti-inflammatory activities, but is used largely for
treatment of pain

Therapeutic Effects: Mefenamic acid is used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a
menstrual period). Mefenamic acid is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes
pain, fever, and inflammation

Uses: Mefenamic acid is used for the short-term treatment of mild to moderate pain from various conditions. It is also used to decrease pain
and blood loss from menstrual periods. Mefenamic acid is known as a nonsteroidal anti-inflammatory drug (NSAID).

Contraindications: Mefenamic acid is contraindicated in patients with salicylate hypersensitivity or NSAID hypersensitivity who have experienced
asthma, urticaria, or other allergic reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactoid reactions to mefenamic acid
have been reported in such patients.

Adverse Effects:
 Bloody urine.
 bloody, black, or tarry stools.
 decreased frequency or amount of urine.
 increased bleeding time.
 increased blood pressure.
 increased thirst.

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 itching, skin rash.
 severe stomach pain, cramping, or burning.

Nursing Implications:

 Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance.
 Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests.
 Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact
physician.
 Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur.

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Generic Name: Ferrous sulfate
Brand Name: Iron
Drug Classification: Belongs to the class of oral iron bivalent preparations. Used in the treatment of anemia.

Mechanism of Action: Iron combines with porphyrin and globin chains to form hemoglobin, which is critical for oxygen delivery from the lungs to
other tissues. Iron deficiency causes a microcytic anemia due to the formation of small erythrocytes with insufficient hemoglobin.

Side Effects: dose related nausea, upper abdominal pain, constipation or diarrhea

Uses: Iron deficiency anemia, blood loss related to pregnancy or GI bleeding (NSAIDs), hookworm infestation, or excess coffee

Adverse Effects:
 Nausea and vomiting
 Stomach pain
 Loss of appetite
 Constipation
 Diarrhea

Contraindication: Patients with hemochromatosis, hemosiderosis or hemolytic anemia

Nursing Consideration:
• Assess nutritional status, bowel function
• Monitor hemoglobin, hematocrit, iron levels
• May cause elevated liver enzymes
• Take on an empty stomach to increase absorption/vitamin c helps with
absorption

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Generic Name: Cefuroxime
Drug Classification: Ceftin
Mechanism of Action: Cefuroxime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Cefuroxime has activity in the
presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive bacteria
Uses: Cefuroxime is used to treat bacterial infections in many different parts of the body. It belongs to the class of medicines known as
cephalosporin antibiotics. It works by killing bacteria or preventing their growth.

Side Effects:

 Chills
 diarrhea
 fever
 general feeling of illness or discomfort
 headache
 itching of the vagina or genital area
 pain during sexual intercourse
 rigidity
 sweating
 thick, white vaginal discharge with no odor or with a mild odor

Adverse Effects:

 Back, leg, or stomach pains

 bladder pain
 bleeding gums
 bloody or cloudy urine

26
  body aches or pain
 burning while urinating
 dark urine
 difficulty with breathing
 ear congestion
 fast, pounding, or irregular heartbeat or pulse
Contraindication: Cefuroxime is contraindicated in patients with cephalosporin hypersensitivity or cephamycin hypersensitivity.
Cefuroxime should be used cautiously in patients with hypersensitivity to penicillin
Nursing Consideration:
 Give oral drug with food to decrease GI upset and enhance absorption.
 Give oral drug to children who can swallow tablets; crushing the drug results in a bitter, unpleasant taste.
 Have vitamin K available in case hypoprothrombinemia occurs.
 Discontinue if hypersensitivity reaction occurs.

27
 Generic Name: KCL tablet
Drug Classification: It is in the electrolyte supplement class of medications.
Mechanism of Action: Potassium ions participate in a number of essential physiological processes, including the maintenance of intracellular
tonicity; the transmission of nerve impulses; the contraction of cardiac, skeletal, and smooth muscle; and the maintenance of
normal renal function.
Uses: Potassium chloride is used to prevent or to treat low blood levels of potassium (hypokalemia). Potassium levels can be low as a
result of a disease or from taking certain medicines, or after a prolonged illness with diarrhea or vomiting
Side Effects: Upset stomach, nausea, vomiting, gas, or diarrhea
Adverse Effects: uneven heartbeat, muscle weakness or limp feeling, severe stomach pain, and numbness
Contraindication:
 high levels of potassium in the blood.
 familial hyperkalemic periodic paralysis.
 a high amount of chloride in the blood.
 Thomsen disease.
 complete heart block.
 decreased kidney function.
 abnormally high levels of nitrogen-containing compounds in your blood.
 severe burn.

Nursing Consideration
 Arrange for serial serum potassium levels before and during therapy.
 Administer liquid form to any patient with delayed GI emptying.
 Administer oral drug after meals or with food and a full glass of water to decrease GI upset.
 Caution patient not to chew or crush tablets; have patient swallow tablet whole.
 Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3–8 oz of cold water, juice, or other suitable beverage, and
have patient drink it slowly.
 Arrange for further dilution or dose reduction if GI effects are severe.
28
 Agitate prepared IV solution to prevent “layering” of potassium; do not add potassium to an IV bottle in the hanging position.

D. CONCEPT MAP

29
30
 X. NURSING MANANGEMENT

X. NURSING MANAGEMENT

Chief Complaint: Vaginal bleeding in the third trimester of pregnancy

Present Health History: A 36 year old G3P0 patient was admitted at Negros Oriental Provincial Hospital on November 26, 2022 with 37 weeks with a
diagnosis of placenta previa.

Past Health History: None

Childhood Illness: None

Immunization: Complete w/ covid-19 vaccine

Allergies: None

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1. Family History with Genogram

2. Psychosocial History

Name: Cadiente, Cynthia Binongo

Age: 36
Civil Status: Married
Date of Birth: October 7, 1986
Occupation: Account Supervisor
Current Living Situation: Happy with her partner
Philhealth: covered by the workplace
Presenting Problems: patient verbalized
History of psychiatric illness and outpatient treatment: None
Role perception: Married for 10 years, extended family
Educational Attainment: College Graduate

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 3. Environmental History
Patient’s current address: Talungan, Bais City, Negros Oriental
-Full concrete house
-Fairly clean, well-ventilated and well-lit
-Electricity provided by NORECO
-Drinking water is commercially available purified water

4. Spiritual History
The patient is Roman Catholic and prays everyday.

PHYSICAL ASSESSMENT
General Survey:
Name of Patient: C. C
Age: 36 yrs. old
 Received patient lying in bed, active and coherent.
Vital Signs:
 T- 36.5 C
 PR-73 bpm
 RR- 22 cpm
 BP- 140/ 90
 IV- D5LR 1L @ 33 gtts/min and PNSS 1L @ 30 gtts/min as side drip.

33
 BODY PARTS NORMAL FINDINGS STUDENT FINDINGS

INTEGUMENTARY
SYSTEM

 Hair/ Scalp  Normal hair distribution, No actual  The patient's hair is shiny and has no hair loss. No presence of
hair loss or any signs of alopecia. nodule and dandruff.
There is the presence of terminal
and vellus hair all over the body. No
nodule upon palpitation and no
areas of excess hair growth on the
body.

 Nails  The patient's nails are short, pinkish  The patient's nail is translucent and shiny. Nails were short. And
in color, and convex in texture. Capillary refill takes 3-4 seconds.
Capillary refill takes 3–4
seconds.

34
  Skin  Warm, dry skin with good turgor
prevents ulcers, bleeding, rashes,
and other abnormal skin
problems. No edema and lesions
palpated
 The skin is smooth, with no lesions, lumps and nodules. candl skin-
colored and has small hairs. No noted discharges. No signs of
infection and no problems. with the patient's hearing.

NURSING THEORY

Myra Levine’s conservation theory for application of nursing process on my patient having placenta previa. This theory involves series of actions that
a nurse takes to conserve health of the patient. It is composed of four components conservation of energy, conservation of structural integrity,
conservation of social and conservation of personal integrity. Advised patient to take more fluids, balanced diet, maintenance of personal hygiene.
Involved patient in decision making regarding her health, encouraged her to take care of herself and fetal well being.

D. GORDON’S FUNCTIONAL HEALTH PATTERN

FUNCTIONAL HEALTH USUAL PATTERN INITIAL PATTERN

35
PATTERN
 Health  Client claim that her health in
Perception the past year has been good.
Health  Client does not smoke and
Management drink alcohol
Pattern  Client does exercises such as
walking.
 Client does not have regular
checkups as claimed.
 Client has not experienced
hospitalization.
 Client did not undergo any
operation or surgery.
 Client claims that she did not
experience any skin trauma.
 Has no known allergy of food
and medication as claimed.
 Client claims that she does not
have difficulty in following the
instruction and advice of
healthcare professionals (e.g
nurse doctor).
 Nutritional  Client claims to take vitamins
Metabolic - Vitamin C
Pattern -Iron
-Folic
-Calcium (start at the 12 weeks
of pregnancy)
 Client claims to not be fond of
Admitted last
Vital signs:
T: 36.5
PR: 73 bpm
BP: 153/93
RR: 19cpm
 Client claims that her health has not been good in the hospital.
 Client does not smoke and drink alcohol.
 Client can’t do exercises since she recently gave birth.
 Client does not have regular checkups as claimed.
 Client had experienced hospitalization due to giving birth.
 Client has undergone operation or surgery (Cesarean section
delivery).
 Client claims that she experiences a skin trauma.
 Has no known allergy to food.
 Client claims that she does not have difficulty in following
instructions and advice of health care professionals (e.g nurse
doctor).
 Client claims to take vitamins.
-Cefuroxime
-Iron
-KCL tablet
 Client claims to have normal appetite but no appetite when admitted
36
 vegetables
 Client claims to have no
difficulty in swallowing.
 Client claims to have meals
3/day and a snack in between.
 No food allergies as claimed
 Food restriction regarding
disease: NONE
 Food dislike: NONE
Typically, daily food intake:
 Rice and more on meat and
chicken
Typically, fluid intake:
 7 – 8 glasses/day as claimed
 Elimination  Client claims to have
Pattern constipation 3x a month.
 Client claims no problem in
urinating and bowel.
Before admission:
Bowel elimination:
 Client claims to have no difficulty in swallowing.
 No food allergies as claimed
 Client claims to have meals 3/day and a snack in between.
 Food restriction regarding disease: NONE
 Food dislike: NONE
Typically, daily food intake:
-Breakfast: eggs and rice
-Lunch: Green vegetables
-Dinner: Vegetable and rice
Fluid intake: 7-8 glasses
Typically, fluid intake:
 Client verbalized “sobra sa 1 liter”
 KCL Drip
 D5LR 1L
 PNSS
 Client claims no problem in urinating and bowel.
During admission:
Bowel elimination:
Frequency: Once a day
Character: Yellow
Consistency: Formed
37
 Frequency: 3x to 4x a week Discomfort: None
Character: brown
Consistency: solid Urinary elimination:
Discomfort: Painful sometimes Frequency: 4x a day (after catheter removal)
Character: Yellow
Urinary elimination: Control Problem: No
Frequency: 4x a day
Character: Yellow
Control Problem: No

 Activity-  Client does exercises such as  Client claimed during her spare time she just wanted to rest in order
Exercise Pattern walking. to recover.
 Client claimed during her spare  Client cannot ambulate alone and require assistance.
time she does house chores.

 Sleep-Rest  Sleeps at 11 pm and wakes up  Sleeps at 11 pm and wakes up at 7am.

Pattern at 6am.  Client does not have difficulty in sleeping or initiating sleep.
 Client does not have difficulty  No sleeping problem as claimed.
in sleeping or initiating sleep.  Experience dreams and early awakenings sometimes.
 No sleeping problem as  Client does not use any medicine to sleep.
claimed.  Client claims to fall asleep easily.
 Experience dreams and early
awakenings sometimes.
 Client does not use any
medicine to sleep.
 Client claims to fall asleep
easily.

 Cognitive-  Client claims she had no  Client claims she had no problem in breathing, hearing, and seeing.
Perceptual problem in breathing, hearing,  Client claims to have no problem with memory and concentration.

38
 Pattern and seeing.  Rate pain as 7/10. · 10 (where 10 is the most painful; and 0 as
 Client claims to have no no pain)
problem with memory and
concentration.

 Self-Perception  Client perceives herself as body  Client claims to be excited because of her 3rd child.
Pattern image as just fine as claimed.  Client perceives herself as body image as just fine as claimed.
 Looks herself of her physical  Looks herself or her physical appearance just right.
appearance just right.

 Role-  Family structure: Extended  Client claims that she talks to her husband if she has any problems.
Relationship Family
Pattern  Does not have any family problem as claimed.
 Does not have any family
problem as claimed.

 Business: Motorparts

 Sexuality-  Sex: Female  Client claims that she is happy with her husband.
Reproductive  Civil Status: Married
Pattern  Client claims that she is happy
with her husband.
 Client claims that she is
satisfied with their intimate
moments.

 LMP: March 11, 2022

 Coping-Stress-  Client claims that she can get  Client claims that being with her husband reduces her stress.
Tolerance stressed but not always.

39
 Pattern  Client claims that she vents her
problems to her husband.
 No medication intake when she
is stressed.

 Valuable Belief  Client is baptized in Roman  Client claims that she prays everyday.
Pattern Catholic since birth as claimed.
 Client claims that she prays
everyday.

SUMMARY OF NURSING DIAGNOSES

 Acute pain related to surgical incision

 Fatigue related to post operative surgery
 Risk for infection related to impaired skin integrity at incision site

NURSING CARE PLAN

40
CUES/ NURSING OBJECTIVES INTEVENTION RATIONALE EVALUATION
EVIDENCES DIAGNOSIS
Subjective: Acute pain Within our 2-days Independent: After our 2-day holistic
Client related to holistic nursing 1. Assess for 1. To aid in nursing care, the client
verbalized surgical care, the client potential understanding reason manages her pain as
“Sakit akong incision will be able to types of for severity of pain evidenced by:
tahi kung mo manage her pain pain that associated with
lihok og inig as evidenced by: may be client’s condition and -Partially met. Client
sulti nako” affecting point toward needed verbalized “murag mo gamay
Rate pain as -Verbalization of client. interventions for pain ang sakit”
8/10 somewhat management.
(whereas 10 controlled pain -Partially met. Facial grimace
is most 2. Note still present.
painful and 0 -Decreased facial location of 2. As this can influence
as no pain). grimacing surgical the amount of -Met. Correctly demonstrating
incisions. postoperative pain the modified pace breathing
Objective: -Correctly experienced. technique
Vital sings: demonstrating
T: 36.5 one 3. Monitor skin 3. Which are usually -Met. Absence of abdominal
PR: 73bpm nonpharmacologi color and altered in acute pain. guarding.
RR: 22cpm cal method that temperature
BP: 140/90 provide relief and vital -Partially met. Normal skin
Facial -Absence of signs. color and vital signs with
grimace abdominal 4. Breathing can actually elevated blood pressure.
noted upon guarding help regulate the Vital signs:
4. Teach
movement heart rate and blood
modified T: 36.5
and talking. -Normal skin pressure which helps
pace PR: 73 bpm
Abdominal color and vital regulate the pain
breathing. BP: 153/93
guarding signs within response in the brain.
RR: 19cpm
upon normal range.
observation. T: Dependent:
PR: 60-80bpm 5. Mefenamic acid is
5. Administer used for short-term
RR: medication
BP: 120/80 treatment of mild to
as ordered: moderate pain.
Mefenamic  Cefuroxime used to
OD, reduce the incidence
Cefuroxime of infections.
TID, KCL  KCL tablet is a mineral
41
tablet OD,
supplement used to
Iron OD.
treat or prevent low
amounts of potassium
TABLE 2: FATIGUE RELATED TO POST OPERATIVE SURGERY

CUES/ NURSING OBJECTIVES INTERVENTIONS RATIONALE INTERVENTIONS

EVIDENCES DIAGNOSI
Subjective: Fatigue Within our 2-day Independent 1. Providing such After our 2-day holistic
Client verbalized related to holistic nursing 1. Provide opportunities promotes nursing care the goal was
“Kapoy na ko post care the patient opportunities to communication and support fully and partially met as
Rating energy operative improves her express concern, and may facilitate coping. evidenced by:
level as 4/10 surgery. sense of energy fears, expectations,
after giving birth, as evidenced by or questions. 2. Participating in - Met. The client verbalized
with 1 having no pleasurable activities can “murag okay-okay na ko
energy and 10 -Positively 2. Provide refocus energy and karun”
fully energized. interacting with diversional diminish feelings of
her newborn at activities. Avoid unhappiness, sluggishness, - Met. Played with her
Objective: least twice both and worthlessness that can newborn and breastfed with
Unfocused on overstimulation and accompany fatigue. good attachment
questions being -Verbalization of underestimation
asked. improved energy 3. This enhances the - Partially met. Claimed she
Disinterest in the 3. Establish realistic commitment to promoting can ambulate with the
surrounding. -Ambulating at activity goals with optimal outcomes. assistance of her husband
Drowsiness least twice in the the client and during re-assessment.
OB ward encourage forward 4. This promotes a sense of
movement. control and improves self- -Answered all our FHP
-Answering at esteem. questions assertively and
least 10 of our 4. Assist the client confidently
assessment to identify
questions appropriate coping -Rated energy level as 6/10
assertively and behaviors.
confidently

-Rating level as
7/10

42
Table 3. Risk for infection related to impaired skin integrity at incision site

Cues/Evidences Nursing Goal/Objectives Interventions Rationale Evaluation

Diagnosis

Subjective: Risk for Within 2 days of Independent: Within 2 days of nursing

infection r/t nursing interventions, 1. Note skin color, interventions, the patient will
Client verbalized impaired skin the patient will be able texture and turgor. be able to:
“Naay times mo integrity at to: 2. Inspect skin on  To assess extent
katol gamay and incision site 1. Identify daily of 1. To identify individual risks
dapit sa akong tahi” individual risk basis,describing involvement/injury factors
factors wound . 2. 2. Verbalized
2. Verbalize characteristics and  To promote understanding of treatment

43
 understanding of changes observed. optimal wound needs
treatment needs 3. Use appropriate healing. 3.Participated to level of
Objective: 3. Participate to barrier dressings  To protect the ability to prevent skin
level of ability to and wound wound and breakdown
Guarding on the prevent skin coverings. surrounding
affected area, and breakdown 4. Elevate lower tissues.
grimacing on extremities  Enhances venous
contact with Long Term: periodically, if return. Reduces
affected area The patient will not tolerated edema formation.
exhibit signs of Dependent: 
Discomfort and
bedsores
itchiness
 Administer
prescribed pain
medications,
antibiotics and
other medications.

44
 CONCLUSION

Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the
management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a
gestational age of <36 weeks, and estimated blood loss >2000 ml.

Placenta Previa defined as a condition that occurs in pregnancy when the placenta abnormally implanted in the lower uterine segment, Partially or
totally covering the internal cervical os. Complete placenta previa is when it covers the internal os, partial is when the placenta partially covers the
os, and marginal is when the placenta approaches the border of the os. The rising incidence of cesarean sections in the last 50 years is partially a
causative factor to the increasing number of cases of placenta previa. The overall prevalence of placenta previa reported in the literature is
approximately 4.0 per 1000 births. Risk factors associated with an increased risk of placenta previa were advanced maternal age, grand multiparity,
history of previous C/S, previous abortion, and smoking during pregnancy. The aim of this study was to review all cases diagnosed with placenta
previa in the last 13 years and identify risk factors for maternal morbidity.

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Hassan S. Abduljabbar, Nedaa M. Bahkali, Samera F. Al-Basri, Estabrq Al Hachim, Ibrahim H. Shoudary, Wesam R. Dause, Mohammed Y. Mira and
Mohammed Khojah Saudi Medical Journal July 2016, 37 (7) 762-766; DOI: https://doi.org/10.15537/smj.2016.7.13259

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Ahn KH, Lee EH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Anterior placenta previa in the mid-trimester of pregnancy as a risk factor for neonatal
respiratory distress syndrome. PLoS One. 2018;13(11):e0207061. [PMC free article] [PubMed]

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