Perfusion: Placental Abruption, Placenta Previa, PP Hemorrhage, Prolapsed Cord and Gestational HTN

Perfusion: Placental Abruption, Placenta Previa, PP

Hemorrhage, Prolapsed Cord and Gestational HTN Leave the first rating Students also studied Terms in this set (46) Save

Q&A: Placenta Abruption & Previa

25 terms elsa2911Preview Postpartum Hemorrhage Practice Q...16 terms LeMoyneFreeman Preview EMT- Jurisprudence Exam 180 terms kwakefield9Preview IV Calc 20 terms S_19 Fetal Circulation Scope of perfusion problems How do these relate to the concept of perfusion?Read the following stripLate decel Placental AbruptionPremature separation of the placenta, or a detachment of part of a normal implanted placenta from the uterus.

Nursing Diagnosis for placental abruption placental abruption risk factorsMaternal hypertension, cocaine use, external abdominal trauma, cig. smoking, previous abruption in a previous pregnancy, thrombophillia (bleeding disorders), multiple gestation Placentral abruption clinical manifestations/complicationsFHR decels, severe abdominal pain, vaginal bleeding, rigid abdomen, increasing fundal height, disseminated intravascular coagulation (DIC)- bleed from IV sites etc.Late decels at first because perfusion. Prolonged decels until death- continually declines.

Placentral Abruption: Nursing AssessmentMonitor maternal VS

Assess FHR/activity- hypoxia can cause increased fetal movement, then nothing.Assess pain- Abruption causes SEVERE PAIN Assess bleeding (vaginal inspection only) Assess abdomen (for being hard in-between contractions due to blood build up.Monitor for signs of DIC Placental Abruption: Nursing InterventionLab tests: CBC w/diff, type and cross-match for blood if theres time. May use exsanguination policy if needed (0-, no type and cross), fibrinogen level to determine clotting ability Bedrest Oxygen Administer IV fluids and or blood products

Prepare for emergency delivery: vaginal/c-sec. (depends on how close to

delivering and amount of bleeding) Placenta PreviaWhen the placenta implants in the lower segment of the uterus and completely or partially covers the cervix, causing bleeding with cervical dilation or effacement.

Complete previa: you dont want mom to go into labor- scheduled sec @ 38-39

weeks. MUST have c-sec.

Nursing Diagnosis: Placenta PreviaRisk for deficient fluid volume

Impaired fetal gas exchange Fear Risk for altered maternal fetal dyad

Placenta Previa: Clinical manifestations

Placental Previa: Nursing AssessmentVaginal Bleeding: how much? what color? (dark red you may see in abruption because it takes awhile for the blood to get out sometimes)

Abdominal Assessment: soft, relaxed, non-tender uterus, normal uterine tone

Diagnostics: Trans-abdominal US

Labs: Coagulation studies (CBC, H&H)

Placenta Previa: Nursing InterventionsAssess VS frequently

Assessment of FHR and fetal activity Monitor amount of bleeding Avoid vaginal exam**** INSPECTION ONLY Avoid interventions that will stimulate uterine activity (stop pitocin) Maintain bedrest (better perfusion to baby) Administer IV fluids and or blood products (if indicated) Prepare for emergency c-section placenta previa s/s placental abrution s/s previa - there is no pain, but there is bleeding abrution - there is pain, but no bleeding (board like abd) post partum hemorrhageThe loss of 500mL of blood (or more) after a vaginal birth and 1000mL of blood or more during cesarean birth.

Nursing Diagnosis: Post Partum HemorrhageRisk for deficient fluid volume

Ineffective tissue perfusion Risk for shock Risk for decreased cardiac output Risk for infection Anxiety Risk for disturbed materal-fetal dyad Postpartum hemorrhage- risk factorsUterine atony Lacerations of the birth canal Placental accreta, increta or percreta (variations in uterine shape), ruptured uterus (VBAC), Inversion of uterus ( can be caused by tugging too much on umbilical cord, not supporting abdomen when doing fundal exams). Coagulation disorders, placental abruption, placental previa, manual removal of retained placenta/membranes, mag. sulf (or other labor meds- relaxes uterus so it cannot contract- high risk) Chorioamnionitis Uterine sub-involution- not contracting

Postpartum hemorrhage- clinical manifestations Brisk/Heavy Vaginal Bleeding If unable to control or stop the bleeding symptoms of hypovolemic shock= Rapid/Shallow respirations Rapid/weak/irregular pulse Hypotension Cool, pale and clammy skin Decreased Urine output Lethargy (possible loss of consciousness if bleeding remains uncontrolled) Anxiety Hypovolemic ShockA condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.Postpartum hemorrhage: nursing assessmentPalpation of pulses, inspection, auscultation (lungs, heart, BS), observation- (RR, LOC, blood flow and color), measurement (blood loss) Estimating blood loss

Postpartum Hemorrhage: Nursing Interventions V/S & SPO2 monitoring

Assessment fundus and flow (measure blood loss) Fundal massage if boggy Assess for other sites of bleeding indicating DIC Continue oxygen if needed to keep SPO2 > 92%

Administer oxytocics to control bleeding:

oxytocin- (can be given IM) methylergonovine maleate (IM or oral) misoprostil (vag or rectally) carboprost (causes severe diarrhea so not 1st option) May need BAKKRI intrauterine balloon if bleeding is not controlled.Keep bladder empty (foley if C-section)- get up to void Q 4 hours even if she doesn't feel like she has to go.IV fluids/ PRBC's Monitor labs for anemia and Rh sensitization Therapeutic communication - keep patient and family informed