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. Oxygenation
3. Pain
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
© 2019 Keith Rischer/www.KeithRN.com
, 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
abruption at 35 weeks tab PO daily
Two spontaneous abortions in the first 2.Acetaminophen 650
trimester mg PO PRN every 6
Menses began at age 12, are usually hours for infrequent,
29 days apart, lasting for 4-5 days, mild 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:
RELEVANT Data from Social History: Clinical Significance:
© 2019 Keith Rischer/www.KeithRN.com
Preterm Labor and Delivery
UNFOLDING Reasoning
Michelle Moore, 38 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Reproduction
2. Oxygenation
3. Pain
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
© 2019 Keith Rischer/www.KeithRN.com
, 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
abruption at 35 weeks tab PO daily
Two spontaneous abortions in the first 2.Acetaminophen 650
trimester mg PO PRN every 6
Menses began at age 12, are usually hours for infrequent,
29 days apart, lasting for 4-5 days, mild 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:
RELEVANT Data from Social History: Clinical Significance:
© 2019 Keith Rischer/www.KeithRN.com
