Expected Outcome

Diagnosis: The complete diagnosis for this patient includes and abruptio placenta secondary to domestic violence Your diagnosis: abruptio placenta You did consider the correct diagnosis in your hypothesis list. 1. 2. 3. 4. 5. Abruption placentae placenta previa uterine rupture cerviatis labor

Expected Hypotheses List:

Items Necessary to Consider Diagnosis

Feel|Abdomen-upperRight or equivalent

Category Definition

A presenting history of late second trimester vaginal bleeding couple with a tender, bruised abdomen s suspicion of traumatic placental abruption. Additional support for the diagnosis presents with her histor and blunt abdominal trauma. Diagnostic support comes from the ultrasound results.

Items Necessary to Justify Diagnosis

Ultrasound|01 Abdomen (Ultrasound) or equivalent Feel|AbdomenupperRight or equivalent

Category Definition

The diagnosis of bleeding placenta preview via ultrasound coupled with a tender uterus and evidence o abdominal bruising all point to domestic violence with an impending abruptio placentae. The violence is abruption and documentation of the positive history and physical findings is very important from the leg

Items Necessary to Rule Out Competing Hypotheses Category Definition

Psychosocial|19 Sexual history, including pregnancies or equivalent Feel|Abdomen-lowerLeft Feel|Abdomen-lowerRight Feel|Genital

Her past gynecological history and exams would be helpful in narrowing the differential diagnosis options. A patient with a past history of ovarian cyst, ovarian torsion, or uterine surgery would prompt evaluation for surgical intervention. Vaginal cultures would establish the

presence of infection such as beta hemolytic strep, chlamydia, gonorrhea, and the exam itself would provide an opportunity to visualize the cervix and rule out any friability, lesions, or lacerations. A urinalysis in the office would assist in identification of a renal origin for the bleeding like pyelonephritis. The CBC would also assist in narrowing the list from an infective cause. It would also rule out an appendicitis if lower quadrant abdominal pain was a presenting symptom. The CBC would be critical in evaluating blood loss, keeping in mind the increase in blood volume with pregnancy.

Items Necessary for a Thorough Workup

Lifestyles|01 Alcohol Lifestyles|08 Substance abuse Psychosocial|01 Abuse-eg. threatened, hit, forced to perform sexual acts [Psychosocial] or equivalent Hematologic|04 Complete Blood Count (CBC) Sphygmomanometer|Arm-Left or equivalent Stopwatch|Ankle-Left or equivalent

Category Definition

Incomplete Diagnosis

A complete psychosocial history is needed to uncover the pathology, which often exists in cases of domestic violence. Intervention by the legal system to protect the patient and her young child would be necessary. In addition to her obstetric consultation a skilled psychosocial intervention to help her enlist legal aid is warranted. However, constant hemodynamic monitoring to determine the extent of her bloo loss is necessary to manage her most immediate problem.

Patient Management

Cate

Required:
Nursing Care02 Intravenous fluids Procedure06 Insert IV or equivalent Nursing Care09 Other... Nursing Care06 Vital signs Collaboration09 Gynecologist / Obstetrician or equivalent Collaboration20 Pediatrician Activity01 Bed Rest Diet09 NPO (Nothing by mouth) Nursing Care05 Observe for

Recommended:
Collaboration23 Psychiatrist Miscellaneous06 Vitamins/minerals Counseling01 Family or equivalent Education10 Disease Process Community Resources03 Domestic Violence Agency or equivalent

Related H&P:
Immunology|23 Coombs Test Immunology|50 Rh Typing Hematologic|49 Type and Screen Special Proced's|02 Amniocentesis or equivalent

Related Lab:
Medical History|01 Allergies [Medical History] Medical History|08 Gynecologic history Lifestyles|07 Over-the-counter drugs: Laxatives, aspirin, cold preparations, etc. General|01 Abuse, e.g. threatened, hit, forced to perform sexual acts [General] or equivalent Medical History|08 Gynecologic history or equivalent

Expected Problem List: