CALAMBA DOCTORS COLLEGE

A WOMAN WITH
PLACENTA PREVIA

Presentation by
GROUP 2 -BSN2C
BAWIIN BENEMERITO BONA
 CONTENT OUTLINE
01 Case Introduction

02 Current trends & Update related to topic

03 Biographical data

04 Health History

05 Integrated Pathophysiology

06 Medical & Nursing Management

07 Nursing Care Plan

CASE INTRODUCTION
DISEASE OVERVIEW
Placenta previa is a problem during pregnancy
when the placenta completely or partially
covers the opening of the uterus (cervix).

SYMPTOMS
Bright red bleeding
The bleeding often starts near the second
half of pregnancy. It can also start, stop, then
start again a few days later.
Mild cramping or contractions in your
abdomen, belly or back.
PLACENTA PREVIA
 CURRENT TRENDS

In systematic reviews, the pooled prevalence of placenta

previa is 4 to 5 per 1000 births but varies worldwide; the

reasons for this variation are unclear. The increase in

placenta previa was associated with increased maternal age,

smoking, private care, previous cesarean section, multiple

gestation, diabetes, hypertension, and assisted reproductive

technology.
 PLACENTA PREVIA

Placenta previa occurs in 0.3-0.5% of all pregnancies; the

risk increases by 1.5-5 fold in women with a history of

cesarean section. With an increased number of cesarean

sections, this risk can be as great as 10%. Other risk factors

include advancing maternal age, multiparity (larger

placenta), erythroblastosis, history of dilatation and

curettage (induced abortion), smoking, and cocaine use.

BIOGRAPHICAL DATA
Patient: Lynn Holloman

Age: 19 y/o G3P0

Sex: Female
CHIEF CONCERN
“I’m bleeding bad.”

HISTORY OF CHIEF CONCERN

Sudden onset of profuse vaginal bleeding while showering.

Emergency call placed after bleeding persisted for 15 minutes.

Blood pressure recorded at 95/60 mmHg, pulse rate at 90 beats/min during

ambulance transport.

Patient "soaked" with three towels during 20-minute transport.

Similar episode occurred 1 week ago at an amusement park.

Did not inform healthcare providers of previous episode as bleeding had stopped

by the time she returned home, initially thought it was the onset of labor.
 OBSTETRIC HISTORY
Therapeutic abortion at age 15.

Spontaneous miscarriage at age 18 (12 weeks gestation).

Current pregnancy was planned.

Sexual partner left school 4 months ago.

Client admits reduced enthusiasm for pregnancy due to partner's departure.

Attending hospital clinic for prenatal care since 4th month.

Kept all prenatal care appointments.

Sonogram at 20 weeks showed adequate fetal growth.

Placenta reported as low-lying.

Few baby supplies purchased; waiting for semester to end before buying more.
CALAMBA DOCTORS COLLEGE

ANATOMY AND Medical

PHYSIOLOGY
(PLACENTA PREVIA)
ANATOMY & PHYSIOLOGY
The placenta is a temporary organ
that forms in your uterus during
pregnancy. It attaches to your uterine
wall and provides nutrients and
oxygen to your baby through the
umbilical cord.

Its principal function is to supply the

fetus, and in particular, the fetal
brain, with oxygen and nutrients.
CALAMBA DOCTORS COLLEGE

PATHOPHYSIOLOGY
Medical

(PLACENTA PREVIA)
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
CALAMBA DOCTORS COLLEGE

PHYSICAL
EXAMINATION
& LABORATORY
RESULT
 PHYSICAL EXAMINATION

General appearance:
Pale-appearing, white, pregnant female.
Height: 5 ft 8 in.
Weight: 140 lb.
 PHYSICAL EXAMINATION
HEENT:
"Shotty" lymph glands palpable on the left
posterior cervical chain.
Throat slightly reddened; swollen mucous
membrane in the nose but not reddened.

Cardiovascular System:
Heart rate: 86 beats/min.
No murmurs detected.
Blood pressure: 90/50 mmHg.
 PHYSICAL EXAMINATION
Abdominal Examination:
Fundal height: 34 cm.
Linea nigra present on the abdomen.
Fetus palpated in the left anterior
position.
Head not engaged.
No uterine contractions noted.
Fetal Heart Rate (FHR): 90 beats/min.
 PHYSICAL EXAMINATION
Pelvic Examination:
Deferred due to ongoing bright red and
profuse vaginal bleeding.
Extremities:
Full range of motion in joints.
Patellar tendon 2+
 VITAL SIGNS
Temperature: 36.3 degrees Celsius

Blood Pressure: 90/50 mmHg

Heart Rate: 86 BPM

Respiratory Rate: 24 BPM

CALAMBA DOCTORS COLLEGE

NURSING MANAGEMENT
 NURSING MANAGEMENT
1. ASSESSMENT:
Regularly assess the patient's vital signs.
Monitor and document the amount and characteristics of
vaginal bleeding.
2. Continuous Fetal Monitoring:
Use electronic fetal monitoring to continuously assess the
fetal heart rate.
Report any signs of fetal distress.
3. Strict Bed Rest:
To minimize the risk of further bleeding and complications.
 NURSING MANAGEMENT
4. Blood Transfusion:
Be prepared to provide blood products as directed in order
to treat any hypovolemia symptoms caused due to
bleeding.
5. Emotional Support:
Provide emotional support and reassurance to the patient
and her family.
Encourage open communication and address any concerns
or fears they may have.
 NURSING MANAGEMENT
6. Education:
Inform the patient about the symptoms of placenta
previa, possible side effects, and the importance of
following doctor's orders.
7. Preoperative and Postoperative Care:
If the patient requires a cesarean section due to
persistent bleeding or other complications, provide
preoperative and postoperative care.
CALAMBA DOCTORS COLLEGE

LABORATORY RESULTS
COMPLETE BLOOD COUNT
Hematology

Low hemoglobin levels in a

patient with placenta previa can
be concerning as it may indicate
anemia. Anemia is a condition
Hemoglobin L 10.7
where the blood lacks enough
healthy red blood cells to carry
sufficient oxygen to the body's
tissues.

Low hematocrit refers to a lower-

than-normal concentration of red
blood cells in the blood.
Hematocrit L 37% Hematocrit levels can be affected
by various factors, including
bleeding, nutritional deficiencies,
and certain medical conditions.
 LABORATORY RESULTS

Urinalysis:
(-) Protein
(-) Glucose
Specific gravity: 1.030
CALAMBA DOCTORS COLLEGE

DRUG
STUDY
 FERROUS SULFATE
INDICATION/
CLASSIFICA MECHANISM OF SIDE ADVERSE NURSING
DRUG DATA CONTRAINDICATIO
TION ACTION EFFECTS EFFECTS RESPONSIBILITIES
N

Iron Nausea, Monitor for signs of

Generic Supplement constipation, allergic reactions.
Replaces iron stores
name: dark stools, Educate on proper
needed for red blood INDICATION:
Ferrous abdominal administration with
cell development, Treatment and
Sulfate discomfort. food.
energy and O2 prevention of iron GI: Nausea,
Provide stool
transport, utilization; deficiency anemia constipation,
softeners for
Brand name: fumarate contains epigastric pain, black
during pregnancy. constipation.
Feratab, Fer- 33% elemental iron; and red tarry stools,
Assess for signs of
Iron gluconate, 12%; vomiting, diarrhea
CONTRAINDICATIO iron toxicity
DOSAGE& sulfate, 20%; iron, INTEG: Temporarily
N (vomiting, diarrhea,
ROUTES: 30%; ferrous sulfate discolored tooth
Hypersensitivity to lethargy).
Pregnancy exsiccate enamel and eyes
iron, SYST:
Adult: PO
Therapeutic hemochromatosis, Hypersensitivity
300-600
outcome: hemosiderosis, reactions (Ferrlecit)
mg/day in
Prevention and peptic ulcer disease
divided
correction of iron
doses
deficiency
 MAGNESIUM SULFATE
CLASSIFIC MECHANISM INDICATION/ ADVERSE NURSING
DRUG DATA SIDE EFFECTS
ATION OF ACTION CONTRAINDICATION EFFECTS CONSIDERATION

Generic
name: INDICATION:
Monitor vital signs
Magnesium Acts as a Prevention and control of regularly, especially
Sulfate calcium seizures in severe pre- respiratory rate and
antagonist, eclampsia and eclampsia. Flushing and heart rate.
Brand name: depressing CNS Used as a tocolytic agent warmth, Assess deep tendon
function. It
Magtrate for preterm labor. Hypotension, Respiratory and reflexes.
decreases
Nausea and CNS depression, Monitor magnesium
acetylcholine
DOSAGE Electrolyte, CONTRAINDICATION: vomiting, leading to levels in the blood.
release, leading
AND Mineral Myasthenia gravis Respiratory respiratory arrest Continuous fetal
to
ROUTES Heart block depression, and cardiac arrest monitoring during
neuromuscular
Laxative Renal failure Weakness and in extreme cases. administration.
blockade. It
Adult: PO Hypocalcemia lethargy Educate the patient
also has
15-60 ml at Fetal distress in the second on potential side
smooth muscle
bedtime stage of labor effects and the need
relaxant
for medical attention
(Milk of properties.
if they occur.
Magnesia)
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

GOALS:
Subjective Data: Risk for deficient INDEPENDENT: INDEPENDENT:
After the nursing
“I’m bleeding bad” Fluid Volume due 1. Evaluate and record 1. To determine the
interventions, the After providing the
as verbalized by to active bleeding the amount of amount of blood loss
patient will be able nursing interventions, the
the patient. as evidenced by bleeding and to help differentiate
to: patient was able to:
Objective data: continuous and appearance of the diagnosis.
Show
V/S profuse vaginal blood such as color 2. To determine the
improvement of Show improvement of
PR: 86 BPM bleeding. and consistency. extent of loss of fluid
fluid balance as fluid balance as
RR: 24 BPM 2. Assess hourly in the body, and the
evidenced by evidenced by stable
BP: 90/50 intake and output. fetal and maternal
stable vital signs. vital signs
3. Assess baseline compensation to
Be free from any
FHR: 90bpm data and note blood loss
signs and Be free from any signs
changes. Monitor 3. To determine any
symptoms of fluid and symptoms of fluid
FHR. changes that might
volume deficit volume deficit during
4. Encourage to do indicate fetal distress.
during the whole the whole stay in the
bed rest 4. To possibly stop or
stay in the hospital
reduce bleeding by
hospital.
reducing physical
activity
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

5. Position the patient with 5. To prevent compression of the vena cava

the pelvis slightly elevated. that might intervene the blood flow
6. To replenish the loss fluid volume in the
6. Encourage to drink enough body.
amount of fluid. DEPENDENT:
1. To increase the amount of oxygen in the
DEPENDENT: body and to saturate decreased
1. Provide supplemental O2 hemoglobin
as ordered via face mask 2. To help replenish the loss fluid in the body
or nasal cannula @ 10 - 12 due to active bleeding
L/min 3. To prevent occurrence of iron-deficiency
2. Administer IV Fluids as anemia.
ordered COLLABORATIVE
3. Administer Ferrous To further assess and specifically identify
Sulfate 1 tablet once a day the occurring problem.
COLLABORATIVE:
Facilitate laboratory work-
up such as CBC and
urinalysis.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Short-term Goal: INDEPENDENT: INDEPENDENT: Short-term Goal:

Subjective Data: After 30 mins of 1. Position the 1. Uteroplacental perfusion and After 30 minutes of
Lynn expresses concern Impaired Gas nursing patient in a left oxygenation are enhanced in this nursing intervention,
about her well-being, Exchange interventions, the lateral position through the reduction the client maintained
stating that she feels related to client will position. of vena cava pressure and the adequate
weak and lightheaded. decreased maintain 2. Monitor vital augmentation of blood flow to oxygenation and
Objective data: hemoglobin & adequate signs regularly, the uterus. perfusion.
Hemoglobin: 10.7 hematocrit oxygenation and including 2. Consistent monitoring enables
g/dl levels as perfusion. continuous the identification of any
Hematocrit:37% evidenced by fetal indications of gas exchange Long-term Goal:
BP: 90/50 mmHg pale Long-term Goal: monitoring. deterioration, thereby After 24 hours of
HR: 86 bpm appearance, 3. Administer guaranteeing timely nursing intervention,
RR: 24bpm hypotension, After 24 hours of supplemental intervention. the patient had no
Profuse, bright red and nursing oxygen as 3. Supplemental oxygen aids in the signs of impaired gas
vaginal bleeding tachycardia. intervention: prescribed. maintenance of adequate blood exchange by the time
The patient will 4. Encourage oxygen levels and promotes of discharge.
have no signs of fluid intake embryonic oxygenation.
impaired gas within 4. Adequate hydration in important
exchange by the prescribed for keeping blood volume up and
time of discharge. limits. stopping more drops in
hemoglobin and hematocrit
levels.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

5. Prompt identification of declining gas

5. Communicate to the exchange enables preventative measures and
patient the significance of opportune interventions, thereby averting
promptly reporting any complications.
signs and symptoms of
deteriorating gas exchange, DEPENDENT:
such as chest pain & 1. Administer blood transfusion as directed to
increased shortness of treat the reduced hemoglobin and
breath. hematocrit levels. This technique enhances
the ability to transport oxygen.
DEPENDENT: 2. Constantly monitor the fetal heart rate in
1. Administer blood order to evaluate the fetal effects of
transfusion as maternal oxygenation. Timely intervention is
prescribed. possible when any fetal distress is promptly
2. Perform Continuous identified.
Fetal Monitoring 3. Regularly check the amounts of hemoglobin
3. Obtain Laboratory and hematocrit in the blood through lab
Tests tests to see how well interventions are
working and help with decision about what
to do next with treatment.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

DEPENDENT: 4. Administer intravenous fluids as prescribed to

4. Initiate maintain adequate hydration and optimize blood
Intravenous Fluids volume, which can positively influence oxygen-
carrying capacity.

COLLABORATIVE: COLLABORATIVE:
1. Consult with 1. Discuss with the obstetrician, in consideration
Obstetrician of the severity of hemorrhage & welfare of the
2. Consult with mother and fetus, the necessity for a CS or
Neonatologist alternative interventions
3. Coordinate with 2. To explore potential neonatal issues and
Blood bank develop a plan for appropriate care if preterm
birth becomes necessary.
3. To ensure the availability of appropriate blood
products for transfusion in the event of
prolonged or severe bleeding.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective Data: Short-term Goal: INDEPENDENT: INDEPENDENT: Short-term Goal:

The patient After 2 hours of 1. Assess the 1. It serves as an important After 2 hours of proper
verbalized “I’m proper nursing patient’s level indicator and help in detecting nursing interventions,
bleeding bad and Decreased interventions, the of early signs of inadequate blood the patient was able to
it’s getting hard cardiac output patient will be able to consciousness. flow. Changes in the level of maintain a normal
to breath”. related to gush maintain a normal 2. Monitor the consciousness might be a sign of cardiac output with
of vaginal cardiac output with vital signs of worsening perfusion. improvements in pulse
Objective data: blood as improvements in the patient 2. Regularly monitoring the and respiratory values.
During Physical manifested by pulse and respiratory regularly. patient's vital signs establishes a
Examination; hypotension, values. . Provide a baseline against which to Long-term Goal:
BP: 95/50 mmHg tachycardia, Long-term Goal: baseline for compare interventions aimed at After 8 hours of nursing
Pulse: 86 bpm hemoglobin, comparison to improving cardiac output. It also intervention, the
RR: 24bpm and hematocrit After 8 hours of be able to helps healthcare providers spot patient has displayed
Hemoglobin: levels are low. nursing intervention, evaluate the any deviations that might point hemodynamic stability
10.7 g/dl the patient will effectiveness to worsening perfusion in cases and manifested no
Hematocrit: 37% display hemodynamic of the actions. where placenta previa is the further signs of
stability and manifest cause of decreased cardiac decreased cardiac
no further signs of output. output.
decreased cardiac
output.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

INDEPENDENT:
INDEPENDENT:
3. To be able to give proper
3. Monitor the amount and type of intervention to the type of bleeding.
bleeding.
4. To quickly detect failing heart
4. Review signs of failure function and imminent shock, allowing
parameters to promote timely for fast interventions to avoid serious
intervention and avoid impending problems and improve outcomes for
failure or shock. both the mother and the fetus.

5. To be able to detect problems and

5. Monitor the fetus. give immediate intervention to the
fetus if the health is also
6. Provide a quiet environment for a deteriorating.
patient.
6. It lowers sympathetic nervous
system activity, promotes relaxation,
and improves tissue perfusion while
lowering stress and heart workload.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

INDEPENDENT: INDEPENDENT:

7. Helps maintain the health of the mother

7. Promote adequate rest and and the development of the fetus by
explain the importance of reducing heart workload, optimizing tissue
decreasing stress. perfusion, and conserving energy.

8. Assist patients with self- 8. Aids in energy conservation, reduces

care activities if needed. heart workload, assures patient safety, and
fosters psychological health and
9. Instruct to avoid or limit independence.
activities as tolerated.
9. Reduces the chance of complications like
10. Restrict vaginal bleeding or syncope, protects the
examination. cardiovascular system from undue strain,
and enhances the safety of both the mother
and the fetus.

10. Promotes maternal and fetal safety by

reducing the possibility of causing bleeding
or aggravating maternal compromise.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

DEPENDENT: DEPENDENT:
1. For fetuses at less than 32 weeks
gestation, when birth is anticipated but
1. Administer drugs as not urgent, magnesium sulfate provides
ordered. neuroprotection. When bleeding occurs,
2. Administer oxygen as corticosteroids are also given to
ordered promote fetal lung maturity.
3. Administer blood or fluid 2. Reduces the risk of problems linked to
replacement as ordered. hypoxemia, maximizes mother and fetal
perfusion, and enhances tissue
oxygenation.
3. In patients with placenta previa, active
bleeding is usually the reason of
decreased cardiac output. Quick blood
transfusions can prevent problems for
both the mother and the fetus by
increasing cardiac output and correcting
the volume of blood in circulation.
 Presentation by

CALAMBA DOCTORS COLLEGE GROUP 2

Thank
You!