CASE STUDY NO. 1Maria, a 29-year-old woman, G2P1 (1001), from Makati City whopresented to Dr. Lizette Chuan, a primary care doctor on January 20, 2022, to establishcare and for a routine well-visit. She was conscious, ambulatory and accompanied byher husband Jay. But she was immediately referred to a hospital due to vaginalbleeding after cervical cerclage. She had previously delivered vaginally her first femaleinfant (3,536 g) after cervical cerclage under the diagnosis of Incompetent cervix. In thepregnancy discussed here, cervical cerclage was performed at 15 weeks gestation forthe prevention of preterm delivery. Ultrasonography at that time demonstrated no abnormal findings. Twelve days after surgery sudden vaginal bleeding occurred. On admission in the 17th week of gestation, slight bleeding from the external cervical oswas noted, and ultrasonography in the hospital demonstrated placenta previa. Theplacenta overlapped the internal cervical os and the distance from the lower placentaledge to the internal os was 28 mm. Despite the administration of oral ritodrinehydrochloride 20mg tab, a ß-adrenergic stimulant, bleeding continued in the amount ofapproximately 800 ml per day. The position of the placenta did not change. Afterappropriate counseling, the patient chose to terminate the pregnancy because she didnot want to undergo the risk of life-threatening bleeding. Cervical os was still closed, and emergency cesarean section was performed on Feb. 11, 2022 at 18 weeks íngestation, 6 days after admission. They opened the abdomen with a vertical midlineincision. A transverse incision of the lower uterine segment was made, and an infantweighing 175 g was delivered. The placenta covered the internal cervical os and wasablated easily. A double-layer closure was performed as usual. The operative bleeding,including amniotic fluid, was 900 ml, but bleeding continued after surgery. Thehemoglobin value was decreased from 8.3 g/dl to 5.6 g/dl, and 5 units of bankedconcentrated red blood cells were transfused with prophylactic administration ofgabexate mesilate for disseminated intravascular coagulation. After blood transfusion,bleeding decreased gradually. Her VS are the following: T = 36.0°C, PR = 97 b/min, RR= 25 b/min and BP = 90/70.With the case given, you are going to make a case study and present to our groupfollowing this format below:Case Study Format:1. Brief description of the disease, Patient’s Background2. Etiology/Cause3. Clinical Manifestations with rationale (Theoretical and Actual)4. Diagnostic Procedures (Theoretical and Actual results and interpretation)5. Risk Factors6. Pathophysiology7. Complications8. Nursing Management9. Medical Management including the Medications / Drug Study10.Surgical Management (If necessary)11. Nursing Care Plan12.Discharge Plan, Patient’s education Health Science Science NursingNURSING NCM106
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