Placenta previa is a condition where the placenta implants low in the uterus, either partially or completely covering the cervical opening, which can cause bleeding and interfere with a normal vaginal delivery. Risk factors include advanced maternal age, prior cesarean deliveries, and multiple gestations. Ultrasonography is used to diagnose placenta previa, but MRI may be needed in cases where the placenta cannot be clearly visualized by ultrasound due to abdominal scarring or obesity.

1. INTRODUCTION
Placenta previa is a condition in which the placenta is located low in the uterine cavity, partially or completely covering the
opening of the cervix. This can cause bleeding and interfere with a normal vaginal delivery. Placenta previa occurs in four degrees:
implantation in the lower uterine rather than in the upper portion of the uterus (low-lying placenta); marginal implantation (the
placenta approaches that of cervical os); implantation that protrudes a portion of the cervical os (partial placenta previa and
implantation that totally obstructs the cervical os (total placenta previa). The degree to which the placenta covers the internal cervical
os is generally estimated in percentages 100%, 75%, 30% and so forth. Increased parity, advanced maternal age, past cesarean births,
post uterine curettage, multiple gestations, and perhaps a male fetus are all associated with placenta previa.
The incidence of placenta previa is approximately 5 per 1,000 pregnancies. It is thought to occur whenever the placenta is
forced to spread to find an adequate exchange surface. An increase in congenital fetal anomalies may occur if the low implantation
does not allow optimal fetal nutrition or oxygenation. The incidence of placenta previa in the United States is approximately 0.5%, or
1 in 200 women. The maternal mortality rate is 0.03%. The retrospective "Maternal Mortality Study" (1979-1986) showed that in 44
maternal deaths, placenta previa was listed as an underlying obstetric condition contributing to death. This resulted in a case fatality
rate of .03%. The incidence of maternal death was 1 in 3,300 cases of placenta previa. There are still no current trends about the
medications and other diagnostic procedures in preventing and curing placenta previa. Ultrasonography is still the basis of diagnosis
but for patient with cases of abdominal wall scarring, obesity, or an incomplete filled bladder, MR imaging reveals placenta previa
since in ultrasonography placenta previa may not be clearly seen due to blockage of cord-placenta insertions or vessels over the cervix
during visualization.

2. The group chooses this case because more clinical skills will be developed by experiencing the clinical management of this
disease-condition and it will enhance one’s knowledge in implementing proper nursing intervention to the patient towards recovery.
PLACENTA PREVIA
Placenta previa is hemorrhage resulting from the low implantation of the placenta on the interior uterine wall. It is common in
multiparous mothers. The cause is unknown.
There are three types of placenta previa. Each type is identified according to the degree to which condition is present (see figure 1-5).
Total placenta previa. This occurs when the placenta completely covers the internal os.
Partial placenta previa. This occurs when the placenta partially covers the internal os
Low implantation of placenta previa. This occurs when the placenta is attached at the opening or border to the cervical os, but not
covering it.

3. Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Client’s response
to medication with
actual side effect
Generic Name:
Cefuroxime Sodium
August 27-28, 2009 750 mg, IVF q 8
hours
It is a anti- infective
drug and its main
action is combat the
preset bacteria and
inhibit increased
growth.
Low respiratory
infections,
Pharyngitis or
tonsillitis
The client did not
exhibit any adverse
reactions from the
drug
Before:
 check the expiration date of the drug
 check the doctor's order
 assess the client's understanding about the drug
 assess for skin allergies
During:
 Reconstitute the drug with 8 ml of sterile water.
 Slowly inject the drug over 3 to 5 mins.
After:
 Evaluate the client for adverse effect.
 Report lack of response, persistent diarrhea or signs ad symptoms of Anemia.
Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Client’s response
to medication with
actual side effect

4. Generic Name:
Ketorolac
Tromethamie
August 27-28, 2009 30 mg, IVF q 6
hours X 6 doses
Possesses anti-
inflammatory,
analgesics ad
antipyretic.
Completely
absorbed following
IM use.
Use for
management of
moderate ad severe
acute pain.
The client did not
exhibit any adverse
reactions from the
drug
Before:
 check the expiration date of the drug
 check the doctor's order
 assess the client's understanding about the drug
During:
 Do not mix IV ketorolac in a small volume with morphine sulfate.
 The IV bolus must be given over o less than 15 sec.
After:
 Monitor for adverse effect.
 Report ay unusual bruising or bleeding, weight gain, swelling of feet/ ankles, increased joint pain, change in urine patterns.
Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
Mechanism of
action
Indication/s
Purpose/s
Client’s response
to medication with
actual side effect

5. frequency of
administration
Generic Name:
Tramadol
Hydrocloride
August 27-28, 2009 100 mg, TID A Centrally acting
analgesic no related
chemically to
opiates. Precise
mechanism is
unknown.
Use for
management of
moderate ad severe
acute pain.
The client did not
exhibit any adverse
reactions from the
drug
Before:
 check the expiration date of the drug
 check the doctor's order
 assess the client's understanding about the drug
During:
 Give the IV dose slowly over a period of 2 mins or as a continuous infusion.
 Oral and IV dose are therapeutically equivalent, may switch to and from the IV form wit o cage in dose as prescribed.
After:
 Monitor for adverse effect.
 Report immediate ay chest pain, increased SOB, or sudden weight gain.

6. Before:
 check the expiration date of the drug
 check the doctor's order
 assess the client's understanding about the drug
During:
 The capsule should be taken 30 mins before eating and is to be swallowed whole.
 Antacid can be administer with omeprazole
After:
Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Client’s response
to medication with
actual side effect
Generic Name:
Omeprazole
August 27-28, 2009 Q 12 hours X 2
doses
Hough to be a
gastric pump
inhibitor and that it
blocks the final step
of acid production.
By inhibiting the
Hydrogen/
Potassium ATP-ase
system at te
secretory surface of
the gastric parietal
cell.
Use for
management of
active duodenal
ulcer, gastric ulcer,
erosive esophagitis
and heartburn
The client did not
exhibit any adverse
reactions from the
drug

7.  Monitor for adverse effect.
 Report to the physician if chest pain, abdominal pain and fecal discoloration occurred.
1. Discharge Planning
i. General condition of the client during discharge
Upon client’s discharge (August 29, 2009), the client appeared neatly dressed with no apparent body odor. He was afebrile.
She was able tolerate minimal levels of activity such as walking, moving from place to place and transferring from sitting to standing
position without dizziness. She was able to take any food tolerated. She also does not perspire excessively or show signs of emotional
distress such as nail biting or avoidance of eye contact.
ii. METHOD approach
Medications Exercise Treatment Health Teaching OPD Follow-Up Diet
 Mefenamic Acid
500 mg capsule
 Cefalexin
 Ferrous Sulfate
Limb Exercise
R: To improve
peripheral blood
circulation.
Deepbreathing
Exercises:
R: To promote
effective lung
expansion.
Minimal
Activities e.g
walking,
transferring
from sitting to
standing position
R: To improve
client’s activity
Limb Exercises
R: To improve
peripheral blood
circulation.
Minimal
activities
R: To improve
client’s activity
tolerance.
The client was
advised the
following:
 The importance
of a clean
environment.
 The significance
of bedrest, eating
healthy foods,
and increased
fluid intake.
 The importance
with complying
with prescribed
Client was
advised to return
to OPD for
follow-up
treatment and
check-up at
September 5,
2009
Advised the client
to increase intake
of foods rich in
protein, calories
and calcium.
Rationale: To
facilitate faster
and effective
wound and body
function recovery.

8. tolerance medications.
Pathophysiology of Placenta Previa (Book-based)
Modifiable factors:
Women who smokes
Nonmodifiable
factors:
Multiparity
Multiple gestation
Previous cesarian
Birth
Uterine incisions
Advance maternal Age
Pregnancy
Uterine
Atrophy
Abnormal Vascularization of
Endometrium
Low Placental
implantation (2nd and 3rd

9. Uterine
Contraction
Decrease
Uterine blood
flow
Partial
Cervical
dilation
Cover
internal OS
Disrupted Placental
attachment
Malpresentation
of fetus
Bright red vaginal
bleeding

10. Diagnostic and Laboratory Procedures
Diagnostic/
Laboratory
Procedures
Date
Ordered and
date Result/s
In
Indication/s
or Purposes
Result/s Normal
Values
(Units used
in the
Hospital)
Analysis and
Interpretation
of results
CBC
>WBC
August 27
2009 –
August 28,
2009
August 27,
2009
CBC is used
as a broad
screening test
to determine
disorder as
anemia.
This is used
to determine
N/A
7.5
N/A
4.1 – 10.9
g/dL
N/A
Normal
>No indicative

11. >Hgb
>Hct
August 27,
2009
August 27,
2009
if there is
infection
present.
A measure of
the packed
cell volume
of red cells,
express as a
percentage of
the total
blood
80
0.266
F (123-153
g/L)
F(0.359-0.466
vol%)
abnormalities
noted.
Abnormal due
to bleeding.
>If
hemoglobin is
low, there is
not enough
oxygen in the
blood.
Abnormal due
to bleeding
and blood loss
during surgery.
>If hematocrit
is low, there is
decreased
blood volume.

12. volume. In caesarean
delivery there
is 500-
1000mL blood
loss.

13. B. Planning Date/time: August 27,2009/8:00 am
CUES SCIENTIFIC
EXPLANATION
NURSING
DX
PLANNING INTERVENTION & RATIONALE EVALUATION
S:
>“Masakit ang tahi
ko sa may puson.”
Pain Scale: 10/10
O:
>weak in
appearance
>restless and
irritable
>pale looking
>tachypnea:RR:24
cpm
>grimace
Post-operative
pertains to the
period of time
after surgery. It
begins with the
patient’s
emergence from
anesthesia and
continues through
the time required
for the acute
effects of the
anesthetic and
surgical
procedures to
abate.
Acute Pain
r/t surgical
incision.
After 30
minutes of
proper nursing
intervention,
the patient will
verbalize
decreased in
pain to a
tolerable state.
From a pain
scale of 10 to
2.
>Build rapport with the patient
R: This is to gain trust by the patient,
thus making working relationship
comfortable for both the nurse and the
patient.
>Place ice pack at the incision site.
R: To reduce the pain and to prevent
hemorrhage by keeping the fundus
contracted.
>Encourage the patient to do breathing
exercises.
R: This will promote good oxygenation,
therefore promote good tissue perfusion.
>Provide emotional support by
encouraging the patient to verbalize what
she feels.
R: This is to increase patient’s self-
worth.
>Assist the patient when turning side to
side.
R: The client is still weak and needs
assistance by the nurse. Turning side to
side every 2 hours promote lung
expansion and it prevents complications
like pressure ulcers and aspiration
pneumonia.
>Administer analgesics as ordered by the
physician.
R: To eradicate, if not, reduce/decrease
the pain.
After 30
minutes of
proper nursing
intervention, the
patient will
verbalize
decreased in
pain to a
tolerable state.
From a pain
scale of 10 to 2.
AEB:
a.) Absence of
grimace
b.) Normal
respiration.
RR:17cpm

14. Date: August 28, 2009
CUES SCIENTIFIC
EXPLANATION
NURSING
DX
PLANNING INTERVENTION & RATIONALE EVALUATION
S: Ø
O:
>with surgical
incision at the lower
abdomen
>inability to sit
>difficulty turning
to side
>weak in
appearance
>restless and
irritable
>pale looking
>tachypnea:RR:24
> grimace
Post-operative
discomfort felt by
the client after the
anesthesia has
subsided causes
pain and will lead
decreased client’s
tolerance to
activity
Impaired
physical
mobility
r/t surgical
incision.
After 30
minutes of
proper nursing
intervention,
the patient will
be able to
gradually
increase
mobility.
>Build rapport with the patient
R: This is to gain trust by the patient,
thus making working relationship
comfortable for both the nurse and the
patient.
>Assist patient in turning side to side
every 2 hours.
R: Turning side to side is important to
promote lung expansion and to prevent
complications like pressure ulcers and
aspiration pneumonia.
>Provide emotional support by
encouraging the patient to verbalize what
she feels.
R: This will increase the patient’s self-
worth.
>Instruct the patient to do breathing
exercises.
R: This will help alleviate the pain and
will promote good oxygenation, therefore
promote good tissue perfusion.
>Administer analgesics as ordered by the
physician.
R: To eradicate, if not, reduce/decrease
the pain.
After 30
minutes of
proper nursing
intervention, the
patient will be
able to
gradually
increase
mobility by
turning side to
side.
AEB:
a.) Absence of
grimace
b.) Ability to
turn side to side
with minimal
assistance.

15. DATE CUES SCIENTIFIC
EXPLANATION
NURSING
DX
PLANNING INTERVENTION &
RATIONALE
EVALUATION
August
27, 2009
S: Ø
O:
>have no oral intake for the
last 8 hours
>chapped lips
>dry mouth
>with surgical incision at the
lower abdomen
>consumed 2 underpad for
the last 24 hours
>weak in
appearance
>restless and irritable
>pale looking
>grimace
>tachypnea: RR=24
>bradycardia: PR=56
>HCT=0.266%
>HGB=80g/L
>urine output=30 cc/hr
Heavy bleeding
may double for
the postpartum
woman, because
she may
haemorrhage
vaginally from
an uncontracted
uterus as well as
internally from
blood vessels
that were not
securely ligated
Deficient
fluid
volume r/t
blood loss
during
surgery
After 1 hour
of proper
nursing
intervention,
the patient
will maintain
fluid balance
in a
functional
level as
evidenced
by:
a. Patient’s
blood
pressure is
100/60
mmHg or
higher
b. Pulse
remains
between
60 and 100
bpm
c. Scant to no
bleeding
on surgical
dressing is
apparent
Independent:
1. Monitor Vital signs of
client’s with deficient fluid
volume every 4hrs. Observe
for tachycardia, tachypnea,
decreased pulse pressure first,
then hypotension, decreased
pulse volume, and
increase/decrease body
temperature.
®Decrease pulse pressure is
an earlier indicator of shock
than is the systemic blood
pressure. Decrease
intravascular volume results
in hypotension and decreased
tissue oxygenation. The
temperature will be decreased
as a result of decreased
metabolism, or it may be
increased if there is a
infection or hypernatremia.
2. Advise client to have
frequent oral hygiene, at least
twice a day.
®Oral hygiene decreases
After 1 hour of
proper nursing
intervention, the
patient will
maintain fluid
balance in a
functional level
as evidenced by:
a. Patient’s
blood pressure is
100/60 mmHg
or higher
b. Pulse remains
between 60
and 100 bpm
c. Scant to no
bleeding on
surgical
dressing is
apparent

16. >Capillary refill=3sec unpleasant taste in the mouth
and allows the client to
respond to the sensation of
thirst.
Collaborative
3. Encourage patient to drink
prescribed fluid amounts
®This provides water for
replacement of intravascular
or intracellular volume as
necessary.
4. Hydrate the client with
ordered intravenous solution
®Intravenous route is one of
the fastest ways to deliver
fluids and medications
throughout the body.
5. Maintain Patent IV access,
set an appropriate infusion
flow rate and administer at
constant rate as ordered.
® Isotonic IVF such as 0.9%
Normal Saline or Lactated
Ringer’s allow replacement of
Intravascular volume.

17. DATE CUES SCIENTIFIC
EXPLANATION
NURSING
DX
PLANNING INTERVENTION &
RATIONALE
EVALUATION
August
29, 2009
S: “Hindi ko magalaw
ang paa ko.”
O:
-Weak in appearance
-Pale
-With limited
movements
-Difficulty
raising/flexing the legs
-Weak peripheral pulses
-Capillary refill =
3seconds
Because a
woman’s
abdominal
muscles are lax
from the
stretching that
occurred during
pregnancy,
abdominal
contents tend to
shift forward and
put pressure on
the suture line
when she is
sitting or
standing, causing
pain and
uncomfortable
feeling.
Risk for
ineffective
tissue
perfusion r/t
immobility
after surgery
After 1 hr of
proper
nursing
intervention,
the client
will
maintain a
capillary
refill of less
than 5
seconds and
will not
report of
calf pain,
redness,
edema, or
areas of
warmth on
lower
extremities
Independent
1. Assist patient in turning
from side to side every 1-2
hours
®Turning helps in venous
stasis, thrombophlebitis,
pressure ulcer formation and
respiratory complication.
2. Assist client in extremity
exercise.
® Helps to prevent
circulatory problem by
facilitating venous return to
the heart.
3. Early ambulation should be
encouraged whenever
appropriate.
® Early ambulation are a
woman’s best safeguards
against lower extremity
circulatory problems
4. Encourage deep breathing
and coughing exercise
® This promotes optimal
After 1 hr of
proper nursing
intervention,
the client will
maintain a
capillary refill
of less than 5
seconds and
will not report
of calf pain,
redness, edema,
or areas of
warmth on
lower
extremities

18. lung ventilation and
perfusion.
5. Ensure that bedcovers must
be loose enough
® Permits free movements of
the toes and feet

19. Assessment Diagnosis Scientific
Explanation
Planning Interventions Rationale Evaluation
S: Ø
O:
 blood loss-
consumed 1
soaked
underpad
 UO- 30cc/hr
 HGT-
0.266%
 HGB-80 g/L
 Pale
 Dyspnea
 Weak in
appearance
 Weak and
thready
 56 bpm-PR
 Restless and
irritable
 RR: 24-
Risk for
Injury r/t
blood loss
during
surgery
Due to large
amounts of
blood loss, there
are possible
conditions that
may occur, and
patient with
hemorrhage have
altered level of
consciousness.
Within 2 hours
of proper
nursing
interventions,
the patient will
have decreased
risk for injury.
 Monitor vital
signs every 15
minutes
 Assist the
client in a
comfortable
position
particularly in
Semi-
Fowler’s or
High Fowler’s
position.
 Encourage the
client to
verbalize her
feelings and
worries.
 Increase
To identify if
there are
changes in the
normal ranges
and to monitor if
interventions
have helped
normalized the
client’s status.
To promote lung
expansion and
facilitate gas
exchange.
To determine the
other signs and
symptoms felt
by the client and
to know the
appropriate
nursing
interventions to
be done.
Within 2 hours
of proper
nursing
interventions,
the patient was
able to have a
decreased risk
for injury.

20. frequent
observation ,
and if
possible, stay
with the client
and enforce
security
measures (e.g
Raise side
rails)
 Encourage the
client to have
bed rest.
 Advise the
client to
increase fluid
intake.
 Administer
medications
as prescribed.
To prevent the
client from
accidentally
falling or other
cause of injury.
To conserve
energy and feel
relaxed.
To replace lost
fluid and
electrolytes.
To facilitate
faster healing
and
management.

21. Subjective Objective Analysis Planning Implementation Evaluation
Ø  blood loss-
consumed 1
soaked
underpad
 UO- 30cc/hr
 HGT-
0.266%
 HGB-80 g/L
 Pale
 Dyspnea
 Weak in
appearance
 Weak and
thready
 56 bpm-PR
 Restless and
irritable
 RR: 24-
Risk for
Injury r/t
blood
loss
during
surgery
Within 2
hours of
proper nursing
interventions,
the patient
will have
decreased risk
for injury.
 Monitored vital
signs every 15
minutes
 Assisted the
client in a
comfortable
position
particularly in
Semi-Fowler’s
or High
Fowler’s
position.
 Encouraged the
client to
verbalize her
feelings and
worries.
 Increased
frequent
observation ,
and if possible,
stay with the
client and
enforce security
measures (e.g
Raise side rails)
 Encouraged the
client to have
bed rest.
 Advised the
client to
increase fluid
intake.
 Administered
medications as
prescribed by
the physician.
After 2 hours of
proper nursing
interventions,
the patient was
able to have a
decreased risk
for injury.