PATHOPHYSIOLOGY Predisposing factors -Advanced Maternal Age -Multipasrity -Previous Cesarean Birth -Uterine Incision -Multiple Gestation Etiology

Precipitating factor - Lifestyle

(Complete Previa)

(Partial Previa)

(Marginal Previa)

(Low-lying Previa)

Uterus contracts and cervix begins to efface and dilate

Villi of the placenta begin to tear away from the uterine wall

Painless Vaginal Bleeding

Continuous Vaginal Bleeding Hypotension Cold, clammy skin Metabolic Acidosis Decrease tissue perfusion Decrease blood volume Decrease urine output

Weak thread pulse decrease oxygen level circulating in the body Shock Death Cesarean Birth Fetal hypoxia

Vaginal or cesarean birth

Assessment Subjective: Medyo masakit pa ang tahi ko, as verbalized by the patient. Objective: Restlessness Facial mask of pain- beaten look Scattered movement Pain scale of: 5/10

Diagnosis Acute pain related to destruction of tissue and surgical repair as evidenced by guarding or distraction of behavior.

Planning At the end of 30 minutes to 1 hour nursing intervention, the patient will be able to demonstrate use of relaxation skills and diversional activities as indicated for individual situation.

Intervention Encourage verbalization of feelings about the pain.

Rationale Provide comfort and prevent the occurrence of anxiety. To give time for the patient to relax. To prevent another complicatio n like bedsore. For the patient to feel comfort during her relaxation time or period. To lessen her feelings of being worried in the pain shes experiencin g To compensat e in the loss energy or strength during the labor and operation. To prevent opening of the incision area or suture part.

Provide quiet environment and calm activities. Provide comfort measures like change in position. Encourage relaxation exercises with the use of individualized tapes like music. Encourage use of diversional activities like TV.

Provide for individualized exercise program that can be continued by the patient when discharge. Identify ways of avoiding or minimizing pain like splinting incision during cough and applying of good body mechanics.

Assessment Subjective: Hindi ako makatulog ng maayos, as verbalized by the patient. Objective: Restlessness Irritability

Diagnosis Sleep pattern disturbance related to psychologic stress as evidenced by difficulty in falling asleep or awakening earlier or later than desired.

Planning At the end of 2 to 3 hours of nursing intervention the patient will be able to report improvement in rest pattern.

Intervention Note circumstan ces that interrupt sleep and pregnancy. Explain necessity of disturbanc es for monitoring vital signs and other care when patient is hospitalize d. Provide quit environme nt and do comfort measures like wash hand or face, then clean and strengthen sheets in preparatio n for sleep. Assist patient to develop individual program of relaxation. Demonstra te techniques like progressive relaxation.

Rationale To minimize disturbanc e and to facilitate rest. To prevent sudden alteration in her v/s and other complicati on that may occur.

For the patient to be comfortab le in her sleeping or rest time.

For the patient to have more knowledge about technique that she must do or apply as her form of relaxation.