Abruptio Placentae with Preterm Labor and Delivery UNFOLDING Reasoning Michelle Moore, 38 years old
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Course
NUR
Institution
NUR
Abruptio Placentae with Preterm Labor and Delivery UNFOLDING Reasoning Michelle Moore, 38 years old Primary Concept Perfusion Interrelated Concepts (In order of emphasis) 1. Reproduction 2. Ox ygenation 3. Pain 4. Clinical Judgment 5. Patient Education 6. Communication 7. Collaboration
, UNFOLDING Reasoning Case Study: ANSWER KEY
Abruptio Placentae with Preterm Labor and Delivery
History of Present Problem:
Michelle Moore is a 38-year-old who is 29 weeks pregnant. She began prenatal care at 18 weeks gestation because she
was waiting to become insured. She is currently in the Labor and Delivery Unit of the hospital following a call to her
primary care provider. She reported that she had a sudden onset of constant severe uterine pain and began to notice that
she had vaginal bleeding that bright red, soaked a maxi pad and then began soaking through her underwear. Her baby has
not been moving as actively as normal since the pain and bleeding started.
Personal/Social History:
Michelle works at a fast-food restaurant, standing on her feet for long hours. She usually works in the evenings and
weekends. She is estranged from the father of the baby. Michelle’s father is able to help her with childcare once or
twice a week. Michelle denies substance use including alcohol during her pregnancy. Michelle smokes 10 cigarettes
daily, and says that she has decreased usage, but the stress of the pregnancy and having little support makes it difficult
for her to quit.
Michelle reports that she usually eats at work to save money, and most meals consist of fried foods and diet sodas.
Michelle has a small apartment, but says she often has difficulty paying the rent on time, since child care is so expensive.
She has a six-year old son who was born prematurely at 35 weeks. Michelle was diagnosed with a partial abruption
during that delivery.
Past Medical History (PMH): Home Meds: Pharm. Expected Outcome:
Classification:
Gravida 4, Para 1 with a partial 1. Prenatal vitamin 1 1. Multivitamin 1. Pt will maintain
abruption at 35 weeks tab PO daily 2. Analgesic adequate iron and
Two spontaneous abortions in the first 2. Acetaminophen 650 vitamin levels during
trimester mg PO PRN every 6 pregnancy
Menses began at age 12, are usually hours for infrequent, 2. Pt will be free of mild
29 days apart, lasting for 4-5 days, mild headaches headaches
with moderate-to-light flow.
Successfully breast fed her first child
for 11 months.
Vaccinations are up to date.
Michelle is biracial: African
American and Asian, and she was
tested for sickle cell trait. Lab results
reveal Michelle is a carrier of the
trait. It is unknown if the father of the
baby is also a carrier.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
38 yrs old Maturity of handling situation
29 weeks pregnant If situation escalates to delivery, will need to take required steps
Present at PCP direction and mobilize appropriate personnel
Severe uterine pain Adds immediate validity to situation – facilitates communication
Bright red vaginal bleeding Uterine pain with bright red blood is an indication of possible
Reduced fetal movement since onset of placental abruption
bleeding and pain Reduction of fetal movement is indication of possible fetal distress
RELEVANT Data from Social History: Clinical Significance:
Works long and night/weekend hours Stress of work combined with poor nutrition, and smoking can
Baby’s father not involved; her father negatively impact fetal development
has limited time to help Support network is insufficient
Smokes Inability to meet financial needs can add psychosocial stress
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