UNIVERSITY OF MAKATI

COLLEGE OF ALLIED HEALTH STUDIES

COLLEGE OF NURSING

A CASE OF A 40-YEAR-OLD FEMALE WITH ABRUPTIO PLACENTA

A Case Study Presented to the Faculty of Nursing

College of Allied Health and Studies
University of Makati

In Partial Fulfilment of the Requirements for Related Learning Experience

Maternal and Child Nursing – OB Ward

Submitted by:
Abordo, Samantha Nicole
Barrientos, Aleona Marie
Del Rosario, Ian Dominic
Edu, Kryzel Jane
Holgado, Joam Jarelle
Laxamana, Alessandra Joyce

11 MAY 2021

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TABLE OF CONTENTS PAGES

I. INTRODUCTION………………………………………………………….……….…. 3
II. NURSING HISTORY………………………………………………………………… 5
III. PHYSICAL ASSESSMENT……………………………………………….………… 8
IV. DIAGNOSTICS AND LABORATORY FINDINGS……………………….……… 11
V. ANATOMY AND PHYSIOLOGY……………………………………….….……… 14
VI. PATHOPHYSIOLOGY……………………………………………….….………… 19
VII. SURGICAL MANAGEMENT…………………………………….….…………… 21
VIII. MEDICAL MANAGEMENT………………………………….….……………… 25
IX. NURSING CARE PLAN…………………………………………………………… 27
X. DISCHARGE PLAN………………………………………………………………… 29
XI. EVALUATION……………………………………………………………..………. 32
XII. BIBLIOGRAPHY…………………………………………………………….……. 34

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I. INTRODUCTION

Pregnancy is the period in which a fetus develops inside a woman's womb or

uterus. There are three stages of pregnancy in which healthcare providers refer to as
trimesters. However, during this period, there are many pregnancy complications that may
arise. Placental abruption is one of the many pregnancy related complication that may
occur. It is also known as abruptio placenta/placentae, is a condition that may occur
unexpectedly during gestational period, posing a risk to both the mother and the fetus.
Abruptio placenta is the early division or premature separation of a normally implanted
placenta from the uterus. During pregnancy, the placenta grows in your uterus. It transports
nutrients and oxygen from you to your baby and aids in the removal of waste from your
baby's blood. It's connected to the inside of your uterus, and your baby's umbilical cord
connects them. The placenta splits from your uterus too quickly, before your baby is ready
to be born, if you have placental abruption.

Abruptio placenta can happen any time after 20 weeks of pregnancy, but it happens
more often in the third trimester. It is a common cause of third-trimester bleeding linked to
fetal and maternal morbidity and mortality, and so it should be considered if bleeding
occurs in the second half of pregnancy. Manifestations may include vaginal bleeding,
uterine pain and tenderness, hemorrhagic shock, and disseminated intravascular
coagulation (Dulay, A., 2020). Still and all, the signs and symptoms of abruptio placenta
depends on the severity or the degree of separation of the placenta from the uterus, and as
well as the loss of blood during the process. According to Dr. Shad Deering (2018), there
are four classifications of placental abruption which is based on the extent and location of
the separation. The four classes are known as class 0, class 1, class 2, and class 3. Class 0
placental abruptions are asymptomatic which means there are no visible or shows no signs
and symptoms at all. Class 1 are called mild placental abruptions and approximately 48%

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of all cases are represented by this figure. Class 2 are moderate placental abruptions and
27% of all cases are considered to be moderate placental abruptions. 24% of all the cases
belong to the class 3 which is believed to be the severe type of placental abruption.

In the United States, abruptio placentae occurs in around 1% of births, with an

extreme abruption leading to fetal death occurring in 0.12% of those (1:830). Abruptio
placentae is a condition that affects around 1% of all births around the world. In terms of
racial predilection, African American women are more likely to experience placental
abruption than white or Latin American women. It is unknown if this is due to
socioeconomic, genetic, or a combination of factors. Patients under the age of 20 and those
above the age of 35 have been shown to have a higher risk of placental abruption. In the
United States, the probability of perinatal death is estimated to be 119 per 1,000
individuals, but this can vary depending on the degree of the abruption and the fetus'
gestational age. Patients with a long history of smoking have a higher prevalence. About
6% of maternal deaths are caused by placental abruption at this time.

This study is very beneficial to the student nurses because it allows them to improve critical
thinking and progress their understanding about this disease. This subject has will not only
provide the student nurses with a piece of advance knowledge, but also encourage the
students to learn more about this disease in order to be prepared for any potential incidences
in the immediate future. It also suggests a plan of action in this scenario and describes a
unique circumstance.

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II. NURSING HISTORY

a. Biographic Data

Name: Patient X

Address: 123-C Alecto Village, Makati City

Age: 40 years old

Gender: Female

Height: 165 cm

Weight: 72 kg

Nationality: Filipino

Religion: Catholic

Civil Status: Married

Date of Admission: May 6, 2021

Hospital: Makati Medical Center

Mode of Admission: Emergency

Date of Interview: May 6, 2021

Informant: Husband

Chief Complaint: Lower abdominal pain and severe vaginal bleeding

Diagnosis: Abruptio Placenta

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b. History of Present Illness

The patient is on her 36th week of gestation when she was brought to the hospital
and was presented with lower abdominal pain and severe vaginal bleeding. Clinical
symptoms and ultrasonographic findings revealed abruptio placenta. The volume of
bleeding was heavy that led to disseminated intravascular coagulation (DIC) and
hypovolemic shock. Nursing interventions such as blood transfusion and therapy to treat
the critical condition were performed. However, the mother’s condition continued to get
worse that made the attending physician decide to perform a caesarian section delivery in
order to save both the mother and her baby.

c. Past Medical History

She had normal deliveries for all her children except for the last one before her
current pregnancy. According to the patient, she also experienced to have abruptio placenta
on her previous pregnancy.

d. Personal/Social History

The patient is known to be a fun person, a compassionate mother to her children,

and a loving wife. The patient is a stay-at-home mom, while her husband serves as a boss
for a private company. On weekends, she enjoys baking and watching movies with her
family as a way to spend quality time with them. She used to drink alcohol every night
when her children are asleep, however, she stopped 3 months before she became pregnant
with her current baby in her womb.

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e. Family History

The patient’s parents are both hypertensive. She is the oldest of three siblings. She
has been drinking wine ever since she turned 28 years old. She also had an exposure to
second-hand smoke due to her husband smoking after eating dinner with the family to
relieve stress from work.

f. Genogram

76, 78, smoker, 72, history 76, A & W

hypertension hypertension of diabetes

40, alcohol
consumption,
abruptio
placenta 40, smoker

38, A &W, 35, A &W

hypertension

15, A &W 12, A &W 8, A &W 4, A &W

LEGEND:

FEMALE MALE

DECEASED FEMALE A & W = ALIVE AND WELL

PATIENT

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III. PHYSICAL ASSESSMENT

The patient is a 40-year-old woman, Gravida 5, Para 4 at 36 weeks of gestation.

She is experiencing sudden abdominal pain and heavy bleeding that leads to disseminated
intravascular coagulation and hypovolemic shock.

Temperature 37°C
Heart Rate 120 bpm
Respiratory Rate 23 bpm
Blood Pressure 110/60 mmHg
Height 158 cm
Weight 60 kg
Diet Diet as tolerated
Contraptions D5W on the right metacarpal vein
Neuro Vital Signs
Eyes 5
Verbal
4
Motor
4

13/15
Total
Date of Interview: Time of Interview:
May 7, 2021 8 AM

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Organ/System Technique Actual Findings Interpretation and

Analysis
Skin Inspection Pallor occur over - Caused by reduced
patient skin. blood flow and
oxygen or by
decreased number of
red blood cells.

Hair Inspection Patient hair is Normal

equally distributed
Head Inspection and Normocephalic Normal
palpation
Ears Inspection Ears are Normal
Symmetrical
without any
discharges.
Able to hear at both
ears.
Eyes Inspection and with Pupil are equally Normal
the use of penlight rounded reactive to
light and it dilates
in the dark.
Nose Palpation Patient can breathe Normal
inspection when one nose
thrill occluded.
Mouth and throat Inspection -Pale lips Pale lips caused by
low red blood cell
count.

Neck Palpation No palpable lymph Normal

nodes

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Thorax and Lungs Palpation and Increase respiratory Due to decrease of

inspection rate oxygen
-Shortness of
Breathe
Heart Auscultation Increase heart rate Due to low blood
volume.
Upper Extremities Inspection Tiny red spots on There is an
the skin near disseminated
Intravenous site. intravascular
coagulation (
deficiency in
clotting factor)
caused by post
surgical operation.
Nails Inspection Pale nail beds Due to blood loss
during post surgical
operation.
Abdomen Inspection and Board like abdomen There is abdominal
palpation bleeding caused by
premature
detachment of the
placenta from the
uterus can lead to
Disseminated
intravascular
coagulation (DIC).

Extended/ Increase -There is concealed

Fundal Height bleeding can lead to
enlargement of the
uterus.

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IV. DIAGNOSTICS AND LABORATORY RESULTS

Analysis &
Laboratory Test Normal Values Actual Findings
Interpretation
CBC (Complete
Blood Count)
Red blood cell 4-6 million cells 3.5 million
Low RBC value due
count /mm3 cells/mm3
to blood loss.

Low protein found

in the oxygen
carrying blood
Hemoglobin 12-15 g/100 ml 10.2 g/100 ml (RBC).

Decreased total
Hematocrit 36% to 48%. 30% percentage of blood
volume due to
blood loss.

Low platelet counts

due to blood loss
that can lead to
Platelet count 150,000-450,000 100,000 cells/mm3 excessive bleeding
cells/mm3
(thrombocytopenia).

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Coagulation Panel
PT (Prothrombin 9.5-12 seconds 15 seconds Prolonged clotting
Time) time caused by
deficiency in
coagulation factors.

Decreased in
fibrinogen levels
caused by heavy
Fibrinogen antigen 2.0 to 4.0 g/L
1.0 g/L bleeding.
test
Deficiency in
clotting factors that
leads to excessive
bleeding.

Blood typing and Patient blood type is

cross-matching O-. The blood type
permitted for
+/- A, B, AB, O Antigen: O- transfusion is O-
Blood test only.

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Kidney Function
Tests

Increased blood
Blood urea nitrogen urea nitrogen
7-20 mg/dl 25 mg/dl
(BUN) indicates impaired
renal function
caused by inability
to excrete urea from
the blood.

Increased creatinine
Creatinine
in blood indicates
Clearance 88-128 ml/min 135 ml/min
impaired renal
function caused by
kidney cannot
excrete waste
product of muscle.

The more
concentrated the
urine, the higher the
Sp. Gravity 1.005-1.0025 1.0030 urine specific gravity.
That indicates
dehydration caused
by blood volume
loss.

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V. ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The organs of the female reproductive system

produce and sustain the female sex cells (egg cells or
ova), transport these cells to a site where they may be
fertilized by sperm, provide a favorable environment
for the developing fetus, move the fetus to the outside
at the end of the development period, and produce the
female sex hormones. The female reproductive
system includes the ovaries, Fallopian tubes, uterus, vagina, accessory glands, and external
genital organs.

LABIA MAJORA

The labia majora, also known as large lips, enclose

and protect the other external reproductive organs.
During puberty, hair growth occurs on the skin of the
labia majora, which also contain sweat and oil-secreting
glands.

LABIA MINORA

The labia minora, also known as small lips, can have a

variety of sizes and shapes. They lie just inside the labia majora,
and surround the openings to the vagina and urethra. This skin is
very delicate and can become easily irritated and swollen.

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CLITORIS

The two labia minora meet at the clitoris, a small,

sensitive protrusion that is comparable to the penis in
males. The clitoris is covered by a fold of skin, called the
prepuce, which is similar to the foreskin at the end of the
penis. Like the penis, the clitoris is very sensitive to
stimulation and can become erect.

VAGINA

The vagina is a canal that joins the cervix to the

outside of the body. It also is known as the birth canal.

CERVIX

The cervix is a cylinder-shaped neck of tissue that

connects the vagina and uterus. Located at the
lowermost portion of the uterus, the cervix is
composed primarily of fibromuscular tissue.

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UTERUS

The uterus is 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 canal through the cervix
allows sperm to enter and menstrual blood to exit.

FALLOPIAN TUBES

These are narrow tubes that are attached to the

upper part of the uterus and serve as pathways for the
ova to travel from the ovaries to the uterus. Fertilization
of an egg by a sperm normally occurs in the fallopian
tubes. The fertilized egg then moves to the uterus,
where it implants to the uterine lining.

OVARIES

The ovaries are small, oval-shaped glands that are located on

either side of the uterus. The ovaries produce eggs and hormones.

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CIRCULATORY SYSTEM

The circulatory system refers to the heart, blood vessels and the
blood. Blood contains oxygen and other nutrients which your body
needs to survive. The body takes these essential nutrients from the
blood. At the same time, the body dumps waste products like carbon
dioxide, back into the blood, so they can be removed. The main
function of the cardiovascular system is therefore to maintain blood
flow to all parts of the body, to allow it to survive. Veins deliver used
blood from the body back to the heart.

HEART

The heart is a muscular pump that is the central component of the

circulatory system. It is divided into a right and left side by a
muscular septum. The muscular component of the heart, the
myocardium, is composed of involuntary cardiac muscle. It is lined
by a membrane called the endocardium internally, as well as an
external epicardium.

ARTERIES

Arteries carry blood away from the heart. They have thick
walls and a narrow lumen, to resist the high pressure from
the blood being forced out of the heart. As the arteries travel
toward the more peripheral tissues, they begin a process of
segmentation, decreasing in diameter and wall thickness
with each division.

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VEINS

Veins are formed with the union of muscular venules. In comparison to

arteries, veins have a relatively thin wall and a larger lumen. The structure of
the walls is similar to that of arteries, but a considerably smaller amount of
muscle is present in the tunica media of veins.

CAPILLARIES

Capillaries are the closest vessels to the organs. Their

walls measure one large endothelial cell in thickness and
provide the only barrier between the blood and the interstitial
fluid of the tissues. They have a narrow lumen which is just
thick enough to allow the passage of the largest blood cells.
The permeability of capillaries varies depending on the
surrounding tissues and the type of junctions between the
adjacent endothelial cells in the vessels wall.

BLOOD

The blood is the mobile component of the circulatory system.

Blood is bright red when oxygenated and dark red/purple when
deoxygenated. Blood consists of a cellular component suspended in
a liquid called plasma.

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 VI. PATHOPHYSIOLOGY Legend: Pathophysiology
Signs & Symptoms Complication

Hypertension

Abdominal Trauma
Maternal Age,
Rupture of blood vessels that connects and Parity
Smoking or placenta and uterus
Cocaine Use Polyhydramnios

Previous history of
Chorioamnionitis Placental Abruption placental abruption

Bleeding

Secrete activated
Concealed Bleeding Revealed Bleeding Tissue factor

Maternal Hypotension
Stimulate clotting
factors
Abdominal or Back Pain

Contraction of
the Uterus
Clot formation Tissue factor might
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Tender Labor
Uterus
 Drop of levels of Enters and spreads
Increased Vaginal clotting factors through the
Fundal Height Bleeding Circulatory System
.
High risk for
Increase Fetal Heart Rate hemorrhage
Hypovolemic Portion of Placenta is not Stimulates
to extract oxygen from
Shock attached to uterus microthrombi
placenta for Gas Exchange

Hypovolemic
Shock
Fetal
Tachycardia
Disseminated Intravascular Coagulation
Remaining portion of
Decreased
placenta cannot
oxygen supply
compensate fetal needs
Obstruction in
capilliaries

Fetal Fetal
Hypoxia Bradycardia Dysfunction of Infarction
Organs

Intrauterine Emergency
Fetal Demise Cesarean Section

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Premature separation of the placenta also called abruptio placentae. Suddenly,
however, it begins to separate and bleeding results. The separation generally occurs late in
pregnancy; even as late as during the first or second stage of labor. The pathophysiology
of abruption is thought to be due to the premature rupture of maternal vessels feeding the
placenta. This leads to blood pooling in the decidua basalis that causes separation along the
decidual-placental interface. Separation between the placenta and maternal vasculature
leads to the impairment of critical placental functions such as the diffusion of nutrients and
waste to and from the fetus, respectively, leading to fetal death.

VII. SURGICAL MANAGEMENT

Cesarean Section

Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through
a cut (incision) made in the mother's abdomen and uterus. Healthcare providers use it when
they believe it's safer for the mother, the baby, or both.

The incision made in the skin may be:

1. Up-and-down (vertical). This incision extends from the belly button to the pubic hairline.

2. Across from side-to-side (horizontal). This incision extends across the pubic hairline. It's
used most often, because it heals well and there is less bleeding.

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Procedure Nursing Responsibilities Interpretation & Analysis

 Assess the woman’s  To provide explanation,

understanding of the clarification, and emotional
procedure. support as needed. Ensure
that the anesthesia will
eliminate any pain during
surgery and that medication
will be administered post
operatively to minimize
discomfort. The woman
who understands about the
procedure to be performed
and what to expect after
PRE-OPERATIVE surgery will be less
CARE anxious.

 To prevent fluid and

electrolyte imbalance.

 Intravenous fluid  To expose the area, and

replacement is initiated prevent the bacteria, and
preoperatively. infection.

 Shave or clip pubic hair.  Skin preparation for the

Operation.

 Cleanse the abdominal  A catheter helps to ensure

area based on type of that the bladder is empty
incision. and as small as possible,
keeping it away from the
 Insert a retention catheter surgical field.
to empty the bladder
continuously.

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 Assist the client to remove  To ensure the safety of the

jewelry, dentures, and nail client. Metal jewelries can
polish, as appropriate. lead to skin burns from any
use of medical equipment
or electric cauterize used to
stop any bleeding, and to
avoid unnecessary things
that not needed in the
operation.

 This collaborative
 Make sure the client’s decision-making process is
signed informed consent is an ethical and legal
on file. obligation of healthcare
providers. It enables the
client to decide which
treatments he/she do or do
not want to receive.

 It provides baseline and

determine the patient's
usual range. Assist in
 Continue assessing maternal identifying deterioration or
and fetal vital signs in improvement in a patient's
accordance with hospital condition. Help to
policy. determine the level of care
required.

 It motivates and support

the mother during surgery.

 Preparing the partner for  Healthcare provider can be

participation in the delivery. the one who can encourage
and support the mother, if
the partner is not allowed
 Encourage and support the to enter inside the delivery
mother and remain with her room.
as much as possible

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 Monitor vital signs.  Vital signs assist in

identifying
deterioration or
improvement in a
patient's condition.
Help to determine the
level of care required.

 Assess for signs of  Hemorrhage is more

POST-OPERATIVE Hemorrhage. common after
CARE Cesarean section,
healthcare provider
needs to be alert
about signs of
Hemorrhage, to
perform immediate
care.
 Once the catheter has
been removed,  To monitor urine
measure the amount outputs.
of urine voided.

 Assess incision.
 Assessing the
surgical site to check
if there are signs of
bleeding or infection.
 Instruct to restrict
physical activity for 6  Infection and
weeks. hemorrhage
are the greatest
postoperative risks,
restricting activities
helps reduce these
risks. So Heavy
lifting, stair climbing,
douching, should be
avoided.

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VIII. MEDICAL MANAGEMENT

DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS/ CONTRAINDICATION NURSING CONSIDERATION

ACTION ADVERSE REACTION

Generic name:  Tranexamic acid is  Tranexamic acid should Side effects:  Known allergy to TXA, Before:
Tranexamic acid an antifibrinolytic be given to all women intracranial bleeding,
agent. It works by with 'clinically side effects, which include severe known defective color  Monitor blood pressure, pulse, and
Brand name: blocking the estimated blood loss of headache (throbbing), diarrhoea, vision, history of venous respiratory status as indicated by
Lysteda, breakdown of more than 500 mL after nausea and vomiting, stomach pain or or arterial severity of bleeding.
Cyklokapron blood clots, which vaginal birth or 1000 discomfort, were more common in thromboembolism or
prevents bleeding. mL after caesarean women who received TA active thromboembolic  Monitor for overt bleeding every
Dosage, Route section, or any blood disease. Greater than 3 15–30 min.
and  Tranexamic acid is loss that is sufficient to hours from traumatic
Frequency: a molecular compromise Adverse Reaction: injury.
analogue of lysine haemodynamic During:
1 g tranexamic that inhibits stability', regardless of
acid fibrinolysis – the the cause of  Visual abnormalities  Stabilize IV catheter to minimize
intravenously as enzymatic haemorrhage. thrombophlebitis. Monitor site
soon as possible breakdown of  Hypotension (with rapid closely.
after giving birth, fibrin blood clots – injection)
followed by a by reducing the After:
second dose if binding of  Nausea
bleeding plasminogen and  Instruct patient to notify the nurse
continues after 30 tPA to fibrin,  Vomiting immediately if bleeding recurs or if
min or restarts thereby preventing thromboembolic symptoms
within 24 h since bleeding.  Diarrhea develop.
the first dose.  Caution patient to make position
 Anaphylaxis changes slowly to avoid orthostatic
Classification: hypotension.
Pharmacologic
Classification:
fibrinolysis
inhibitors

Therapeutic
Classification:
hemostatic agents

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 DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS/ CONTRAINDICATION NURSING CONSIDERATION
ACTION ADVERSE REACTION

Side effects
Generic name:  Antenatal steroids  Corticosteroids are  Hypersensitivity to Before:
Dexamethasone dexamethasone can given when preterm  upset stomach dexamethasone or any
cross the placenta delivery (less than 37 component of the  Asses active infections; renal or
Brand name: to mature the fetal weeks) is expected.  stomach irritation formulation; systemic hepatic disease; hypothyroidism,
Adrecort, lung and brain. In They are associated fungal infections. ulcerative colitis; diverticulitis;
Dexamet the lung, antenatal with a decreased risk of  vomiting active or latent peptic ulcer;
Drenex, steroids can neonatal respiratory inflammatory bowel disease,
Oradexon decrease the fetal distress, necrotizing  headache hypertension.
lung fluid through enterocolitis, and
activation of intracranial  dizziness During:
Dosage, Route ENaCs, induce the hemorrhage. Steroids
and production of are also believed to  insomnia
Frequency: surfactant proteins improve fetal morbidity  Observe the patient for rales or
and lipid synthesis, by reducing the crackles or dyspnea. Notify the
 restlessness
6 mg IM and and alter preterm incidence of respiratory physician immediately if these
repeat every 12 responses to distress syndrome and clinical manifestations are noted.
 depression
hours for total of oxidative stress. intraventricular
4 doses. hemorrhage, as well as
 anxiety
maternal morbidity.  Discontinue drug gradually under
the guidance of the physician.

Adverse Reaction:
Classification: After:

Pharmacologic
 skin rash
Classification:  Report unusual weight gain,
Glucocorticostero swelling of the extremities,
id  swollen face, lower legs, or
muscle weakness, black or tarry
ankles
stools, fever, prolonged sore
Therapeutic throat, colds or other infections.
Classification:  vision problems
anti-
inflammatory,  cold or infection that lasts a
immunosuppressa long time
nt
 muscle weakness

 acne

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 IX. NURSING CARE PLAN

Assessment Nursing Diagnosis Inference Planning Intervention Rationale Evaluation

Subjective Cues: Bleeding related to Abruptio Placenta is Short Term Objective: Independent: Independent: Short Term Objective:
“My lower placental separation defined as the After 2-3 hours, the patient will: - Ensure safety of the patient - During the time, the patient will (FULLY MET)
abdomen hurts. I from uterine wall as premature separation - Have decreased pain scale of by raising side rails try to manage pain by trying After 3 hours of
also notice some evidenced by of the placenta from at least 4/10 different positions. Nurse must nursing intervention:
bleeding in my profuse vaginal the wall of the womb, raise side rails to avoid injury to - Patient’s pain scale
vagina.” as bleeding uterus, before - Reduce bleeding and - Provide emotional support the patient. is reduced to 3/10.
verbalized by the delivery. The placenta maintain fluid volume by giving assurance
patient. is attached to the fetus - Emotional support and assurance - Bleeding is reduced.
Objective Cues: through the umbilical - Understand and apply pain can help patients to deal with Fluid volume is
- Abdominal cord. Detachment of alleviating techniques - Alleviate pain by teaching their symptoms. It can also maintained.
pain scale: the placenta can cause deep breathing techniques, improve the healing process and
8/10 bleeding, abdominal Long Term Objective: and distractions such as recovery. - Patient understood
- Vaginal pain, or decreased After 24 hours, the patient will: meditation, reading books, and applied pain
bleeding fetal movements. - Patient’s blood volume and or plant imagery. - Given techniques can help alleviating
- G5 P4 haemoglobin level will return alleviate pain by diverting the techniques.
- V/s to normal Dependent: mind of patient into different
- Administer analgesics as activities Long Term Objectives:
T: 36.8° C ordered by the physician After 24 hours of
BP: 110/70 mm Dependent: nursing intervention:
Hg - Administer IV fluids as - Analgesics or painkillers are (FULLY MET)
RT: 22 cpm ordered by the physician administered to help relieve pain. - Blood volume and
PR: 102 bpm haemoglobin levels
- Administration of IV fluids are of patient is back to
- Transfuse properly typed used to restore loss fluids and normal
and crossed-matched electrolytes
blood as ordered by the
physician
- Blood transfusion is a way to
Collaborative: restore blood loss. Proper typing
- Check haemoglobin level in and cross matching are important
collaboration with to check the compatibility of
laboratory department blood to the patient.

Collaborative:
- Collaborate with laboratory - A low haemoglobin level is at
department and blood bank risk for anemia and hypoxia.
to ensure proper blood This determines the need for a
group and blood availability blood transfusion.

- This ensures the compatibility of

blood with the patient.

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 Assessment Nursing Diagnosis Inference Planning Intervention Rationale Evaluation
Subjective Cues: Ineffective tissue Abruptio Placenta is Short Term Objective: Independent: Independent: Short Term Objective:
- Reduced perfusion related to defined as the After 2-3 hours, the patient - Assess and monitor vital - Assessing and monitoring vital (FULLY MET)
fetal premature abruption premature separation will: signs of the patient signs of the patient can After 2 hours of
movements of placenta as of the placenta from - Be relieved of fetal distress determine the clinical status of nursing intervention:
as verbalized evidenced by the wall of the womb, - Monitor fetal heart tone the patient - Fetal distress was
by the excessive blood loss uterus, before - Have normal fluid volume frequently relieved
maternal delivery. The placenta - To determine any signs of fetal
patient is attached to the fetus Long Term Objective: - Ensure the patency of the distress - Fluid volume was
Objective Cues: through the umbilical After 24 hours, the patient will: IV line restored and
- Maternal cord. Detachment of - Oxygen saturation and blood - To avoid blood clotting that returned to normal
cramping the placenta can cause volume will return to normal Dependent: might alter the administration of
- Profuse bleeding, abdominal - Administer IV fluids to the fluids Long Term Objectives:
bleeding pain, or decreased maternal patient as ordered After 24 hours of
fetal movements. by the physician Dependent: nursing intervention:
FHR: 180 bpm - IV fluids are administered to (FULLY MET)
GA: 36 weeks - Administer oxygen to the maintain fluid volume of the - Oxygen saturation
mother as ordered by the patient and blood volume
physician returned to normal
- Oxygen administration to the
- Transfuse properly typed mother can help provide oxygen
and cross-matched blood to to the fetus
the patient as ordered by the
physician - Blood transfusion is a way to
restore blood loss. Proper typing
and cross matching are
Collaborative: important to check the
- Prepare for the immediate compatibility of blood to the
delivery of the fetus in patient.
collaboration with medical
staffs Collaborative:
- If the fetus is at term, delivery is
- Collaborate with laboratory the preferred intervention to
department and blood bank relieve fetal distress.
to ensure proper blood
group and blood availability - This ensures the compatibility of
blood with the patient.

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X. DISCHARGE PLAN

Medication -Educate the patient about the action and side effects of the
medications.
- Take your medications as prescribed.
- To avoid preterm birth, tocolytic drugs such as magnesium sulfate
and nifedipine can be given to inhibit uterine contractions.
- Prenatal vitamins of 0.4mg folate are recommended to take because
low folate has been linked to placental issues and abruptions.
-Ferrous sulfate capsule at least twice a day for 1 month.

Exercise/Environment - Avoid heavy lifting, strenuous exercise and excessive stair

climbing.
- Try to get as much rest as you can especially bed rest.
-Avoid having sexual intercourse.
-exercise for at least 1 minute by just walking.
- Reduce your risk of trauma – for example, wear a seatbelt when
travelling in a car and avoid the possibility of falls

Treatment -Follow up with your healthcare provider as directed for you and
your baby’s updated condition and situation.

Health - The patient should be advised to pay attention on monitoring her

Teaching/Hygiene
blood pressure.
- Maintain a regular pre-natal check-up schedule during your
pregnancy.
-Try to sleep early at night to promote recovery and recuperation.
-Practice having a regular bathing for good personal hygiene and
fresh feeling.

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Observable Signs and Contact your primary healthcare provider or gynecologist if:
Symptoms
-You have a fever.
-You have a small amount of vaginal bleeding (spotting).
-You have severe abdominal or back pain.

Diet/Nutrition - Limit the intake to high sodium and fatty foods. Sodium-
restricted diets can range from 2 to 4 grams a day, depending
on the type of restriction. Foods such as dried meats, frozen
soups, and soy sauce can be discouraged.
-Encourage to consume nutrient-rich calories, high fiber diet,
Iron, B12 and DHA nourishment.
-Drink more water unless you have cardio or renal problems.
- Avoid all substances during pregnancy including cigarettes,
alcohol, medicines (unless prescribed by your doctor) and
street drugs.

Spirituality -Encourage the patient to pray and communicate with her faith
as a source of encouragement, devotion, optimism, and
consolation in her illness.
- Talk to your loved ones, family or friends to lessen the
anxiety that you’re feeling and also to promote guidance and
emotional support.

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DIET PLAN

Meal Menu Pattern Day 1 Day 2 Day 3 Day 4

Menu Menu Menu Menu
Break *Cold/Hot beverage -250ml -250 ml -250 ml -1 cup of
fast *Meat/Fish/Egg/Poultry fresh milk skim milk hot skim hot
*Soup/Porridge/Bread/Whe (109) (83) milk chocolate
at/Cereal/ Rice -1 -2 boiled -2 slices of -2 slices of
scrambled egg (156) garlic wheat grain
egg (91) -1 bowl bread bread
-1 bowl of chicken -1 bowl of -1 cup of
chicken porridge cereal pork rice
And Sweet (181) -500 ml porridge
Corn Soup -500 ml water -600 ml
(155) water water
-500 ml
water

Morning -100 g -100 g -1 apple -1/2 cup of

Snack Greek watermelon grapes and
yogurt 1 orange
(59)
Lunch *Rice/Bread/Wheat -1 cup -1 cup -1 cup -1 cup
*Meat/Egg/Fish/Poultry white rice white rice white rice white rice
*Vegetables/Legumes (206) (206) -1 steamed -1 tuna
*Fruit/Dessert -100 g -1 fried chicken fillet
*Beverage chicken tilapia (129) -1 cup of -1 cup of
(239) -2 cups of stir fried chopsuey
-2 cups of chopped broccoli -1 cup of
fresh sauteed and carrots sliced
Cooked broccoli -2 cups of cubes
Spinach (140) sliced melon
(148) -1 orange cubes ripe -1 cup of
-100 g (60) mangoes strawberry
banana And 1 apple -600 ml of and
(89) (95) water blueberry
-500 ml -600 ml shake &
water water 500 ml
water
Afternoon -100 g -100 g of -100 g of -100 g
Snack steamed Greek Greek steamed
sweet yogurt with yogurt sweet
potatoes nuts potatoes
(86)

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Dinner *Soup/Vegetable -1 cup -1 cup pork -1 cup of -1 cup

s chicken sinigang chicken brown rice
*Meat/Poultry/Fi vegetable (290) garlic soup -1 cup of
sh soup (134) -1 tuna -1/2 cup of chicken
*Beverage -100 g sandwich white rice popcorn
salmon fish (187) -1 cup -1 slice of
fillet (211) -1 cup strawberry fried
-1 cup orange juice shake salmon
lemon juice (70) & 500 -500 ml -1 cup of
(53) & 500 ml water water green tea
ml water -1 banana
-1 apple (95 89
1. Total 1, 895 kcal 1, 786 kcal 1, 800 kcal 1, 945 kcal
calorie
per
day
2. High High High High
Nutrition protein, protein, protein, protein,
al Fiber, Fiber, Fiber, Fiber,
intake Iron, B12 Iron, B12 Iron, B12 Iron, B12
Moderate Moderate Moderate Moderate
carbohydrat carbohydrat carbohydrat carbohydrat
es and es and es and es and
fats as fats as fats as fats as
tolerated tolerated tolerated tolerated

XI. EVALUATION

The case study is about a 40-year-old female with abruptio placenta. In the initial nursing
care plan that was formulated by the student nurses, the patient verbalizes that her lower
abdomen hurts and she also notice some bleeding in her genitalia. For the diagnosis it was
bleeding related to placental separation from uterine wall as evidenced by profuse vaginal
bleeding with the objective cues of abdominal pain with a scale: 8/10, vaginal bleeding,
gravida 5, parity 4, decreased blood pressure and increase in pulse rate and respiratory rate.
The nursing care plan implemented by the nurses throughout the healthcare interventions

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help the patient to improve her general condition as her vital signs return within the normal
range, patient’s pain scale is lessened to 3/10, bleeding is reduced and fluid volume is
maintained, understood and applied pain alleviating techniques to reduce the pain.

For the next nursing care plan created by the student nurses with its diagnosis of
ineffective tissue perfusion related to premature abruption of placenta as evidenced by
excessive blood loss. The objective cues are maternal cramping, profuse bleeding, a fetal
heart rate of 180 bpm and a gestational age of 36 weeks. The nursing care plan employed by
the nurses during the healthcare interventions help the client to relieve the fetal distressed,
fluid volume to be restored and returned to normal as well as the oxygen saturation and blood
volume. As a result, both of the nursing care plans has fully met the goals of assisting the
patient in dealing with abruptio placenta and was given a suitable and reasonable discharge
plan for continued care of the mother and baby. The patient has some concerns about the
drug and the diet plan that has been prescribed. The client is very compliant with the
discharge plan, verbalizes understanding and appreciation with the health education
provided, and follows the diet plan proposed.

The researchers’ recommendation for the management of the case abruptio placenta is
usually a medical emergency situation which is needed to address immediately to prevent
further complications for the mother and the baby. Being mindful of the findings such as
vaginal bleeding, uterine or abdominal sharp pain and board-like abdomen/tenderness,
decreased blood pressure, increase in pulse rate and respiratory rate that are all possible sign
and symptoms of abruptio placenta. The researchers also suggest a diet plan with high in
protein, fiber, iron, B12 and DHA diet and moderate carbohydrates and fats to patients with
abruption placenta and proper hydration with water unless with patient that has cardio and
renal problems.

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XII. BIBLIOGRAPHY

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