PLACENTAL ABRUPTION (Abruptio Placentae) WITH PRETERM LABOR AND DELIVERY UNFOLDING Reasoning Case Study Answer Key

Abruptio Placentae with b b




Preterm Labor and Delivery
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UNFOLDING Reasoning b




Michelle Moore, 38 years old
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Primary Concept b



Perfusion
Interrelated Concepts (In order of emphasis)
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1. Reproduction
2. Oxygenation
3. Pain
4. Clinical Judgment b


5. Patient Education b


6. Communication
7. Collaboration


© 2019 Keith Rischer/www.KeithRN.com
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, UNFOLDING Reasoning Case Study: ANSWER KEY b b b b b



Abruptio Placentae with Preterm Labor and Delivery b b b b b b



History of Present Problem: b b b


Michelle Moore is a 38-year-old who is 29 weeks pregnant. She began prenatal care at 18 weeks gestation because she
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was waiting to become insured. She is currently in the Labor and Delivery Unit of the hospital following a call to her
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primary care provider. She reported that she had a sudden onset of constant severe uterine pain and began to notice that
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she had vaginal bleeding that bright red, soaked a maxi pad and then began soaking through her underwear. Her baby has
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not been moving as actively as normal since the pain and bleeding started.
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Personal/Social History: b


Michelle works at a fast-food restaurant, standing on her feet for long hours. She usually works in the evenings and
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weekends. She is estranged from the father of the baby. Michelle’s father is able to help her with childcare once or
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twice a week. Michelle denies substance use including alcohol during her pregnancy. Michelle smokes 10 cigarettes
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daily, and says that she has decreased usage, but the stress of the pregnancy and having little support makes it difficult
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for her to quit.
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Michelle reports that she usually eats at work to save money, and most meals consist of fried foods and diet sodas.
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Michelle has a small apartment, but says she often has difficulty paying the rent on time, since child care is so expensive.
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She has a six-year old son who was born prematurely at 35 weeks. Michelle was diagnosed with a partial abruption
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during that delivery.
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Past Medical History (PMH):
b b b Home Meds: b Pharm. Expected Outcome: b


Classification:
• Gravida 4, Para 1 with a partial b b b b b b 1. Prenatal bvitamin b1 1. Multivitamin 1. Pt will maintain b b


abruption at 35 weeks
b b b b tab PO daily
b b b 2. Analgesic adequate iron and b b b


• Two spontaneous abortions in the first
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trimester
b mg PO PRN every 6
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• Menses began at age 12, are usually b b b b b b hours for infrequent,
b b b 2. Pt will be free of mild b b b b b


29 days apart, lasting for 4-5 days,
b b b b b b b mild headaches
b b headaches b


with moderate-to-light flow.
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• Successfully breast fed her first child b b b b b


for 11 months.
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• Vaccinations are up to date. b b b b


• Michelle is biracial: African b b b


American and Asian, and she was
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tested for sickle cell trait. Lab
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results reveal Michelle is a carrier of
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the trait. It is unknown if the father
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of the baby is also a carrier.
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What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
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RELEVANT Data from Present Problem: Clinical Significance: b b b b b


• 38 yrs old • Maturity of handling situation
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• 29 weeks pregnant • If situation escalates to delivery, will need to take required steps
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• Present at PCP direction and mobilize appropriate personnel b b b b b b b


• Severe uterine pain • Adds immediate validity to situation – facilitates communication
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• Bright red vaginal bleeding • Uterine pain with bright red blood is an indication of possible
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• Reduced fetal movement since onset of placental abruption b b b b b b b


bleeding and pain b • Reduction of fetal movement is indication of possible fetal distress
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RELEVANT Data from Social History: b b b b Clinical Significance: b


• Works long and night/weekend hours b b b b • Stress of work combined with poor nutrition, and smoking can b b b b b b b b b


• Baby’s father not involved; her father b b b b b negatively impact fetal development
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has limited time to help b b b b b • Support network is insufficient b b b


• Smokes • Inability to meet financial needs can add psychosocial stress b b b b b b b b