Case Study

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I. ACKNOWLEDGEMENT

We would like to thank our beloved family for their support and understanding when we are doing this case. To our group mates who shared their ideas and knowledge, for the patience, for the understanding, encouragement and hard work that they had given through the entire process and helped bring out the best in us during our hard time on the hospital duty.

We would like to express our gratitude on the management and staff ofUnciano Medical Center and to our Clinical Instructor Mrs. Ma. Luz Dieron and to our Head Nurse Ms. RoanneCeninfor their guidance and understanding.

We would also like to acknowledge Mrs. N.C and his relatives for being approachable and cooperative in sharing and giving us the information regarding his present condition.

And above all, we all like to give thanks to God our Lord that gives us the inspiration and positive throughout this case.

I. INTRODUCTION

In partial fulfillment of the NCM 107 requirements, we the group 2 of section A, were given the opportunity to study and assist in challenging cases in Unciano Medical Center. Our exposure to various cases gave us the chance to enhance the attitude, knowledge and skills that we have learned from Unciano Colleges Antipolo.

For our case study, our group decided to focus on the case of Mrs. N.C female, 21 years old who had been diagnosed with Abruptio Placenta and undergone Cesarian Section because of his cooperativeness, status of the recent condition, and patients will. This case will serve as an opportunity for the client to acquire knowledge regarding his condition.

We devoted ourselves to carrying out the nursing responsibilities assigned to us, both in assisting to restore Mrs. N.C ’s health, as well as in establishing nurse-patient interaction so that he will cooperate with us as we gather information to aid his in regaining health and attaining optimum level of functioning.

II. BACKGROUND OF STUDY

Abruptio Placenta
* Painful bleeding
* Placenta is implanted correctly but it begins to separate and bleeding result * Separation generally occurs late in pregnancy
* It may occur as late as during 1st stage of or second stage of labor * Cause is unknown
* Predisposing Factors
* Highly parity
* Advanced maternal age
* Short umbilical cord
* Chronic hypertensive disease
* Pregnancy induced hypertension
* Direct trauma (as form an automobile accident or intimate partner abuse) * Vasoconstriction from cocaine or cigarette use
* Thrombophilitic conditions that lead to thrombosis such as auto immune antibodies, protein C, and factor V Leiden it may be caused by chorioamnionitis infection of the fetal membranes and fluid * Signs and Symptoms

* Premature separation of placenta follow b y a rapid decrease in intrauterine volume, such as occurs within sudden release of amniotic fluid * Sharp, stabbing pain high in the uterine fundus as the initial separation occurs * If labor begins with separation, each contractions will be accompanied by pain over and above the pain of the contractions * Heavy bleeding

* Extreme bleeding if placenta separate first
* Uterus becomes tense and feels rigid to touch
* Couvilaire uterus or utero-placental apoplexy forming a hard board like uterus * Complications
* Disseminated intravascular Coagulation
* Diagnostics
* Bleeding Time
* Hemoglobin level
* Typing and cross matching
* Fibrinogen level
* Blood Clotting – draw 5 ml and place it in a clean, dry test tube, stand it aside uncovered for 5 minutes if the clot not formed suspect interference with blood coagulation * Therapeutic Management

* Need Intravenous fluid for fluid replacement
* Oxygen mask to limit fetal anoxia
* Monitor fetal heart sounds externally to establish baselines and observe progress * Record maternal vital signs every 5 to 15 minutes to establish baselines and observe...
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