Question

A 22-year-old woman presents to the hospital at 34 weeks gestation. She is G1P1. It was an uncomplicated pregnancy until 12 hours prior to admission, she experienced escape of fluid from the vagina, non-foul smelling.

She developed fever (38.2 degrees centigrade) around 6 hours prior to admission and she currently experiencing mild to moderate uterine contractions. She was started on antimicrobial treatment per IV. FHR is 118 bpm, RR=28   PR=90 BP= 110/70

Write an NCP about: Abruption of placenta where placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, producing haemorrhage
IS this an actual problem or potential? (please answer :( )

2. Prepare an NCP following the format:

3.1. Subjective/objective data

3.2. Nursing Diagnosis

3.3 Rationale (should indicate book sources or references)

3.4 Goals/ objectives

3.5 Nursing interventions

3.6. Scientific rationale for the interventions

3.7. Evaluation criteria

Answer 1

Write an NCP about: Abruption of placenta where placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, producing haemorrhage
IS this an actual problem or potential?Prepare an NCP following the format:

3.1. Subjective/objective data

3.2. Nursing Diagnosis

3.3 Rationale (should indicate book sources or references)

3.4 Goals/ objectives

3.5 Nursing interventions

3.6. Scientific rationale for the interventions

3.7. Evaluation criteria

Is this an actual problem or potential- Abruption of placenta- Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients. Symptoms include vaginal bleeding, stomach pain and back pain and it occurs most commonly around 25 weeks of pregnancy. This can decrease or block the baby's supply of oxygen and nutrients and cause heavy bleeding in the mother. Placental abruption often happens suddenly. Left untreated, it endangers the life of both the mother and the baby. Placental abruption can cause life-threatening problems for both mother and baby.

For the mother, placental abruption can lead to:

• Shock due to blood loss
• Blood clotting problems
• The need for a blood transfusion
• Failure of the kidneys or other organs resulting from blood loss
• Rarely, the need for hysterectomy, if uterine bleeding can't be controlled

For the baby, placental abruption can lead to:

• Restricted growth from not getting enough nutrients
• Not getting enough oxygen
• Premature birth
• Stillbirth

Hence you are facing a patient with real problem but not potential.

Nursing Care Plan

3.1 Subjective / Objective Data-

Objective data- 22-year, 34 weeks gestation, G1P1.

Foetal heart Rate	118/min
Respiratory Rate	28/min
Pulse	90
BP	110/70
Temp	38.2C

Subjective Data-

· escape of fluid - bleeding

· Fever

· Mild to moderate uterine contraction

3.2 Nursing Diagnosis

The types of abruption placenta are measured according to the degree of placental separation that has occurred

Grade 0. No indication of placental separation and diagnosis of slight separation is made after birth

Grade 1. There is minimal separation which causes vaginal bleeding, but no changes in foetal vital signs occur

Grade 2. Moderate separation occurs and foetal distress is already evident. The uterus is also hard and painful upon palpation

Grade 3. Extreme separation; maternal shock and foetal death is imminent if no interventions are done.

Ultrasound scan can be used to identify the extent of abruption.

3.3 Rationale of Placental abruption

· High parity. A woman who has given birth multiple times predisposes herself to abruption placentae.

· Short umbilical cord. A short umbilical cord could cause the separation of the placenta especially if trauma occurs.

· Advanced maternal age. Women over the age of 35 years old have higher risk of acquiring abruption placentae.

· Direct trauma. Any trauma to the abdomen could cause a separation of the placenta.

· Chorioamnionitis. This is an infection of the foetal membranes and fluid that could predispose the woman to premature placental separation.

3.4 Goals and Objectives

· Reduce bleeding

· Manage Pain

· Keeping the vital under control- FHR need special monitoring.

3.5 Nursing Interventions and Rationales

• Assess and monitor vaginal bleeding- Excessive bleeding may result in shock. Amount of obvious blood may not fully indicate severity due to possible internal bleeding.
• Obtain history from patient- Determine time bleeding began, any history of pregnancy complications or abdominal/uterine trauma

• Place patient on bed rest in lateral position- This position helps avoid pressure on the vena cava to avoid decreased cardiac output

• Initiate IV access with large bore line- IV fluids will be given to manage hypovolemia and blood transfusion may be required
• Assess abdomen for uterine tenderness and contractions- Uterus may be tender upon palpation, tense and rigid.

• Monitor maternal vitals for signs of shock- Watch for signs of hypovolemia to include tachycardia, tachypnea and hypotension

• Place and observe external foetal monitoring for signs of foetal distress- This allows you to monitor foetal heart rate and contractions to observe for variability and responsiveness of the foetal heart rate. A lack of variability or decelerations indicate foetal distress.
• Abdominal, back and uterine pain may accompany bleeding and at times may be severe, especially with contractions.
• Provide alternative options for pain relief if able
• Provide patient education- Help patient to feel more informed and lessen anxiety