The placenta is an organ that develops in a woman's uterus during pregnancy

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The placenta is an organ that develops in a woman's uterus during pregnancy. The placenta provides the growing fetus with nutrition and oxygen and removes waste from the womb (Bhide & Thilaganathan, 2019). It also serves as a way to connect the baby with the mother through the umbilical cord as it attaches at the side or the top of the uterus. Placenta previa is a complication that occurs when the placenta covers totally or partially the cervix. Placenta previa can be life-threatening since it causes excessive bleeding during delivery, or before it is born (Bhide & Thilaganathan, 2019). Maternal prognosis is only okay if there is a way to control bleeding. The fetal prognosis, on the other hand, depends on the blood lost and gestational age.

On the other hand, anemia can be controlled through a blood transfusion to allow the full development of the pregnancy. In rare cases, a woman can experience placenta previa at the end of the first trimester. The problem is generally experienced in the last two trimesters (Bhide & Thilaganathan, 2019). A woman with placenta previa can experience bleeding throughout the pregnancy and also during delivery. If the problem does not resolve, then a C-section is done to deliver the baby.

This nursing care plan aims to manage and treat placenta previa through assessing, diagnosing, planning, implementing, and evaluating. Through the nursing plan, we aim at ensuring that the baby is delivered safely and is viable. One of the therapies that shall be included in the treatment is the IV line through the application of a large-bore catheter.

Assessment

The 32-year-old patient, who is at the 32 weeks of her pregnancy, complained of progressive blood loss on arrival to the hospital. On assessment, the patient manifested bleeding episodes for the last five days. She insisted that she had not been involved in any form of an accident before the bleeding started. She also said that she had no pain and that she still felt the movement of the fetus. During the general examination, we noted that though the bleeding was not extreme, we needed to change her pad at least every five hours. Her blood pressure was low, and her abdomen soft when palpated. She also had a decreased respiratory rate at 11 breaths per minute, with the fetal heart rate lower than the standard rate of 90 breaths per minute. Her blood pressure is at 118/73, her temperature is at 98.6 F, and her oxygen saturation at 97%. Her skin was clammy, cold, and pale, while she also complained of increased urine output. Her hemoglobin level was at 11.6. Patient does not have a past medical history of any disease.

Diagnosis

Generally, placenta previa is diagnosed by performing an ultrasound on the patient (Carusi, 2018). While the patient had earlier gone through a routine ultrasound, we shall conduct another one to check why she is experiencing the current vaginal bleeding during her last appointment. Since she is in her second trimester, the ultrasound will be easy and more viable to perform. The diagnosis of placenta previa combines transvaginal ultrasound and abdominal ultrasound, which is conducted through a wand-like device placed inside the patient's vagina (Carusi, 2018). The positioning of the transducer will be done carefully to avoid causing more bleeding or disrupting the uterus. Possibly, if the bleeding is heavy, which is a high indication that the patient has placenta previa, then we shall avoid the normal vaginal exams to reduce heavy bleeding risks. If necessary, we shall perform more ultrasounds to determine the exact positioning of the placenta and determine if the placenta previa issue is resolved. This nursing diagnosis is related to Florence Nightingale’s concepts and theory because they provide a road map of promoting healing and routine clinical practice. Importantly act as a custodian of ethics and care environment, which gives quantities and considerate process that attains an optimum healthcare delivery.

Planning

One of the goals in this care plan is to ensure that the mother and the fetus are safe. To do this, we will record all the vital signs of the mother, assess the level of bleeding, and maintain a count on the perineal pad. Weighing the pad before and after use will help to determine the level of bleeding. We shall also observe if the patient is in shock by checking on her pulse, moist skin, pallor, or low blood pressure. To reduce the risk of losing the pregnancy, the patient will be admitted and restricted from movements. Blood episodes will continue to be checked to determine if it is increasing or dropping.

The client, together with the family, will explain the condition and how it can effectively be handled. To ensure that there is enough blood supply for both the mother and the child, the patient will be advised to rest on a side-lying position. A sonogram could also be ordered to localize the patient's placenta. In case the condition does not improve, then a cesarean birth could be administered from the 36th week. The patient could be discharged if her bleeding stops for more than 48 hours after admission and be administered to bed rest. The patient should nevertheless return to the hospital immediately in case the bleeding returns to avoid any risks. The patient should also be advised on maintaining high hygiene levels to avoid infection during and after delivery. Importantly, the care plan will involve addressing the psychosocial and emotional needs of the patient. We shall also offer the patient emotional support to avoid episodes of depression or anxiety during the pregnancy and even afterward.

Interventions

One of the interventions will be to assess the vaginal bleeding through weighing pads. This intervention will help to estimate the amount of blood loss, as well as a gauge if the blood is old blood or active bleeding. Placing the mother on the left-side lying position is an essential intervention, for it helps to improve the flow of blood to the fetus, kidneys, uterus, and heart (MacGibbon & Ius, 2018). When awake, the mother should be placed on a position that elevates her pelvis for the same benefits mentioned above. More interventions will involve monitoring the patient for dehydration, for this can cause the patient to go into a shock. Placing the patient on fluid IV will help her body to retain homeostasis, as well as to remain hydrated.

To enhance fetal pulmonary maturity, the patient will undertake a course of antenatal corticosteroid therapy. This is a therapy that is administered to symptomatic mothers that are above 33 weeks of gestation. Since her first bleeding occurred past the 34th week of gestation, she will be given a course of steroids. She will also be scheduled to deliver the baby through cesarean before the 37 weeks, to avoid losing the child. Due to the intensive bleeding, the patient should be administered some parenteral iron supplements that will help correct any form of anemia (MacGibbon & Ius, 2018). The parenteral oral supplements cause a fast rise of hemoglobin levels, while also reducing gastric upset experienced when a patient is on oral supplementation (Allahdin, Voigt, & Htwe, 2017). The patient will also be given stool softeners and be advised to take foods in high fibers, such as fruits and vegetables, to minimize constipation, leading to further bleeding due to excessive straining.

To minimize risks of RhD alloimmunization, the patient will be administered anti-D-immune goblin. The administration could be administered as the bleeding continues, but there will be no administration after bleeding stops. In case the bleeding does not stop or reoccurs within three weeks after the administration, the entire episode is repeated (Allahdin, Voigt, & Htwe, 2017). There will be no need to re-administrate the RhD alloimmunization if the delivery of the child occurs three weeks after administration unless there is a major detection of fetomaternal hemorrhage.

Evaluation

Since there is a clear indication that the patient has placenta previa, and that the fetus is viable, a cesarean delivery will be most likely indicated by the physician. Indeed, there is an obstetric emergency in this case since the patient has shown a placenta previa that is causing an actively bleeding placenta. Based on the previously conducted lab tests and mother and fetal assessment, the patient needs to remain hospitalized for further examinations and assessment, as she awaits delivery. While in the hospital, her maternal blood loss will be assessed and improve, a step meant to improve her hemodynamic status.

The patient will require a complete blood count and recognition of her blood type or crossmatch in case she requires a transfusion during delivery or after. Her fibrinogen level will also need evaluation, and thromboplastin time evaluated due to the great loss of blood she has sustained. Also, the heart rate of the fetal will be monitored. After undergoing the support therapy, the patient responded positively. Nevertheless, she will still be scheduled for cesarean delivery due to the risk of recurring bleeding.

In case the patient is discharged before the date of delivery, she will be given a bed rest to limit the chances of the bleeding recurring and she will be provided education about measures needed to be taken at home. Generally, placenta previa treatment depends on the severity and extent of bleeding, condition of the baby, and the gestation age, position of the fetus and placenta (Allahdin, Voigt, & Htwe, 2017), and lastly, on whether the bleeding successfully stops after the intervention.