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Nursing Care Plan for Placenta Previa - Fluid Volume Deficit

Monday, February 10, 2014

Placenta Previa is abnormally located placenta, which is on the lower uterine segment so as to cover part or all of the opening of the birth canal.

According to Brenner et al (1978) found in the last half of pregnancy, placenta previa incidence of 8.6% or 1 in 167 pregnancies, 20% of which are placenta previa totalis (Williams, 847).

The frequency of placenta previa in primigravida aged over 35 years is approximately 10 times more often than primigravida aged less than 25 years. In the grand multipara aged over 30 years is approximately 4 times more often than grand multipara aged less than 25 years (Kloosterman, 1973).

The exact cause of placenta previa is unknown to date. But the reduced vascularity in the lower uterine segment due to uterine scar surgery, molar pregnancy, or tumors that cause so much lower placental implantation is a theory about the cause of placenta previa.

It is understandable that if the blood flow to the placenta is not quite like the twin pregnancy the placenta is normally though to expand its location so close to or covering the surface completely opening the birth canal. In addition, multiple pregnancy / more than one that requires a larger surface for the implantation of the placenta may also be one of the causes of placenta previa. And also the blood vessels that previously experienced changes that may reduce the blood supply to that area, it is a predisposing factor for the low implantation in subsequent pregnancies.

There are 4 degrees of abnormality of placenta previa based on placental tissue palpable through the birth canal opening at a specific time, namely:
  1. Placenta previa totalis, when the entire opening (ostium of the internal servisis) covered by placental tissue
  2. Placenta previa partialis, when most of the opening (ostium of the internal servisis) covered by placental tissue
  3. Marginal Placenta Previa, where the placenta is located right on the edge of the edge of the opening (ostium of the internal servisis)
  4. Low-lying placenta, where the placenta is abnormally located in the lower uterine segment is not to cover the opening of the birth canal or the placenta is located 3-4 cm above the edge of the surface so it will not palpable at the opening of the birth canal.

Clinical Symptoms
  1. Bleeding without pain, gestational age over 22 weeks.
  2. Recurrent bleeding.
  3. Bleeding can occur after micturition or defecation, physical activity, Braxton Hicks contractions or coitus.
  4. Starters rarely so severe bleeding. Usually the bleeding will stop on its own and occur again unexpectedly.
  5. The color of fresh red bleeding.
  6. The presence of anemia and shock in accordance with the discharge of blood.
  7. His usually no.
  8. The taste was not tense on palpation.
  9. FHR sound.
  10. Palpable placental tissue in the vagina.
  11. The decrease in head does not enter the pelvic inlet.

Physical examination
  1. External examination of the presenting part is usually not entered the pelvic inlet.
  2. No abnormalities of the pelvic location of the fetus.
  3. Inspeculo examination: Bleeding originating from the cervical os eksternum.

Diagnostic / Investigations

1. USG ( ultrasonography )
Can reveal the position of the low lying placenta but whether placental lining the cervix unusual disclosed.

2. X-ray
Revealed soft tissue density to reveal the body parts of the fetus.

3. Laboratory tests
Hemoglobin and hematocrit decreased. Clotting factors are generally within normal limits.

4. Assessment of vaginal
This assessment will diagnose placenta previa but should be postponed if possible until viability is reached (preferably after 34 weeks). This examination is also called the dual arrangement procedure (double setup procedure). Double setup is sterile vaginal examination is performed in the operating room with the readiness of the staff and tools to effect a Caesarean birth.

5. Isotope Scanning or the location of the placenta placement.

6. Amniocentesis, if 35-36 weeks of pregnancy is achieved, ultrasound guidance on amniocentesis to assess lung maturity (ratio of lecithin / spingomyelin [LS] or presence phosphatidygliserol) is guaranteed. The birth of the surgery immediately recommended, if the fetal lungs are already mature.



Nursing Care Plan for Placenta Previa

Nursing Diagnosis : Fluid Volume Deficit related to excessive bleeding due to abnormal placental implantation, the risk of separation with cervical dilatation

Goal:
  • Fluid volume needs of clients are met.
Outcomes:
  • Clients can indicate stability / improvement of fluid balance as evidenced by stable vital signs, capillary refill quickly, as well as expenses and adequate urine specific gravity individually.

Nursing Interventions and Rationale :

1. Evaluation, report, and record the number and nature of blood loss.
Rationale : Estimate blood loss help differentiate the diagnosis.

2. Do bed rest, instruct the mother to avoid the Valsalva maneuver and coitus.
Rationale: Bleeding can be stopped by reduction activity. Increased abdominal pressure or orgasm may stimulate bleeding.

3. Position the mother with the right, with the pelvis elevated supine or semi-Fowler position.
Rationale : Ensures adequacy of blood available to the brain, pelvic elevation to avoid compression of the vena cava. Semifowler position allows the fetus acts as a tampon.

4. Record vital signs, capillary refill in the nail beds, mucous membranes or skin color and temperature.
Rationale : Helps determine the severity of blood loss, although cyanosis and changes in blood pressure and pulse are further signs of loss of circulating volume.

5. Monitor uterine activity, fetal status, and presence of abdominal tenderness.
Rationale : Helps determine the nature of the possible effects of hemorrhagic and hemorrhagic events.

6. Avoid rectal or vaginal examination.
Rationale: It enhances hemorrhagic.

7. Give intravenous solution, plasma expanders, blood complete, or packaging cells, as indicated.
Rationale: Increasing the volume of circulating blood and deal with the symptoms of shock.

8. Monitor input / output fluid. Get a urine sample every hour, measure the specific gravity.
Rationale: Determine the extent of loss of fluid and showed renal perfusion.

9. Auscultation of breath sounds.
Rationale: adventitus breath sounds indicate imprecision / excess turnover.

10. Prepare for cesarean birth.
Rationale: Hemorrhage stopped when the placenta is removed and closed venous sinuses.

11. Save tissue or products of conception exit.
Rationale: Physicians should evaluate the possible retention of tissue, histologic examination may be required.

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