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Placenta Previa

Placenta Previa

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Published by Alynna Valbuena

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Published by: Alynna Valbuena on Feb 26, 2012
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01/12/2013

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Placenta previa
is the development of placenta in the loweruterine segment, partially or completely covering the internalcervical os. The cause is unknown, but a possible theory states thatthe embryo will implant in the lower uterine segment if the deciduasin the uterine fundus is not favorable. Complications are immediatehemorrhage, shock, and maternal death; fetal mortality; and postpartum hemorrhage.Signs and Symptoms:Vaginal bleedingContractionsPatient X is a 37- year old Filipina female who is living with herfamily at Look, Salay, Misamis Oriental. She is from Quitoan,Bacolod. Her religion is Iglesia ni Cristo. She is a high schoolgraduate, non-smoker, non –alcoholic, and no allergies reported.Patient has placenta previa with bleeding during her delivery.Patient X was admitted last Novemer 29, 2009 at NNMC –DRbecause of abnormal separation of the placenta. With that, patient Xundergone cesarean section. Patient X is multigravida. Shedelivered a post term operative baby boy 43 weeks of gestation 3.4kg with an APGAR score of 3,6,7 vertex, placenta previa, accretawith anemia. Patient X has two full term baby weighing 5 lbs and 6lbs. Patient is referred to NNMC from Balingasag, Provincial Hospital.
Vital signs
 The patient vital signs are one of the most important data thatshould be given a direct attention because it will serve as basis indetermining any risk factors towards the patient. The increase anddecreased of the vital sign of the patient must be monitored in orderto determined whether the patient is at risk or not. The patient had the following vital signs upon admission: BP- 120/90mmHg, PR- 80 bpm ; RR-22 cpm; and temp- 36°c .
CASE STUDY 
 
AssessmentNursing DxPlanningNursing InterventionsRationale
S-O-> Bleeding Episodes(amount, duration)> Facial Grimace due of Pain> Complaint of painAbdomen soft/hard whenpalpated> Manifest BodyWeakness> Low BPIncreased HRDecreased RRDeficient FluidVolume r/t ActiveBlood Loss Secondaryto Disrupted PlacentalImplantationShort Term:After 4 hours of NI, the ptwill verbalizeunderstanding of causative factors.Long Term:After 4 days of NI, the ptwill maintain fluidvolume at a functionallevel AEB individuallyadequate urinary outputand stable vital signs.1. Establish Rapport2. Monitor Vital Signs3. Assess color, odor,consistency and amount of vaginal bleeding; weighpads4. Assess hourly intakeand output.5. Assess baseline dataand note changes. MonitorFHR.6. Assess abdomen fortenderness or rigidity- if present, measure abdomenat umbilicus (specify timeinterval)7. Assess SaO2, skincolor, temp, moisture,turgor, capillary refill(specify frequency)1. To gain patient’s trust2. To obtain baseline data3. Provides information aboutactive bleeding versus old blood,tissue loss and degree of blood loss4. Provides information aboutmaternal and fetal physiologiccompensation to blood loss5. Assessment providesinformation about possibleinfection,placenta previa or abruption. Warm,moist, bloody environment is idealfor growth of microorganisms.6. Detecting increased inmeasurement of abdominal girthsuggests active abruption7. Assessment providesinformation about blood vol., O2saturation and peripheral perfusion8. To detect signs of cerebral
NURSING CAREPLAN
 
Fetal HR >120-160 bpm> Decreased Urine Out> Increased UrineConcentration> Pale, Cool Skin>Increased CapillaryRefill8. Assess for changes inLOC: note for complaints of thirst or apprehension9. Provide supplementalO2 as ordered via facemaskor nasal cannula @ 10-12L/min.10. Initiate IV fluids asordered (specify fluid typeand rate).11. Position Pt. in supinewith hips elevated if orderedor left lateral position.12. Monitor lab. Work asobtained: Hgb & Hct, Rh andtype, cross match for 2 unitsRBCs, urinalysis, etc.Scheduled forultrasound asordered.perfusion9. Intervention increasesavailable O2 to saturate decreasedhemoglobin10. For replacement of fluid vol.loss11. Position decreases pressure onplacenta and cervical os. Left lateralposition improves placentalperfusion12. Lab. Work provides informationabout degree of blood loss;prepares for possibletransfusion.Ultra sound provides info about thecause of bleeding

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