PAMANTASAN NG LUNGSOD NG MARIKINA COLLEGE OF NURSING

LESSON PLAN

In Partial Fulfillment of the Requirements for the Degree BACHELOR OF SCIENCE IN NURSING In Related Learning Experience

Submitted to: Prof. Vilma S. Cordova, RN, MAN (LEVEL COORDINATOR)

Submitted by: Bucala, Jeffrey C. BSN 401 GROUP 1 January 6, 2014

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TOPIC Placenta Previa SEMESTER 2ND Semester , 2013-2014 REFERENCE Brunner and Suddarths., Textbook of Medical Surgical Nursing Eleventh, Edition Vol. 1 Pillitteri A., Maternal and Child Health Nursing: Care of Childbearing & Childrearing Family vol.1 4th ed., Nettina, SM.; Mills, EJ, Lippincott Manual of Nursing Practice, 8th Edition OBJECTIVES In teaching these topics the students will able to: Assess a client's health status and risk factors involved in the disease process Identify actual/risk diagnosis Plan and implement appropriate interventions for the promotion of health and management of the disorder of pregnancy Evaluate the client outcomes of a healthy status Utilize the nursing process in the holistic care of client for the promotion and maintenance of health Learn the anatomy and physiology involve Describe the pathology of the disease Ensure a well-organized recording and reporting system ENGAGEMENT & EXPLORATION Applying lecture drills and encouraging the students to recite according to their seat number to ensure each student is cooperate, and pays attention to what are being discussed. Giving right acknowledgement to students who recite and answer the questions correctly. Emphasize the key points of the subject matter to prevent information overload. Having an individual quiz to evaluate among the students.

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EXPLANATION PLACENTA PREVIA

A. Description: The placenta partially or completely covers the internal os of the cervix. The inferior edge of placenta load at the lower uterine segment, or even reach the internal cervical os after 28 weeks gestation. the most common bleeding disorder of the third trimester Incidence rate: Internal0.24% -1.57% International0.5% - 0.9% Types of Placenta Previa:

1) Complete or Total Placenta Previa the placenta completely covers the internal os when the cervix is fully dilated. 2) Partial Placenta Previa the placenta partially covers the internal os. 3) Marginal Placenta Previa the edge of the placenta is lying at the margin of the internal os. 4) Low lying Placenta Previa the placenta implants near the internal os, its edges can be felt by the examining finger on IE. B. Risk Factors 1. High-risk group Age of gravida>35 Multipara Pregnancy women used to tobacco 2. Initial etiologic agent Damage of endometrium Development of the trophoblastic layer of fertilized ovum delayed Anomaly of placenta

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C. Physical Exam/Manifestation Painless vagina (occurs after 20 weeks of gestation) External bright-red bleeding Uterus is soft , non-tender and relaxed Negative fetal distress Fetal parts are palpable and countable D. Laboratory: Complete blood count (CBC) To monitor mothers blood volume. E. Diagnostics: 1) Transvaginal ultrasound If a woman is bleeding she is usually placed in the labor and birth unit or for cesarean birth because profound hemorrhage can occur during the examination. This type of vaginal examination knows as the double- setup procedure. 2) Ultrasonographic scan If ultrasonographic scanning reveals a normally implanted placenta, an examination may be performed to rule out local causes of bleeding and a coagulation profile is obtained to rule out other causes of bleeding management of placenta previa depends of the gestational age and condition of the fetus and the amount and cesarean birth. 3) Fetoscope To monitor fetal heart rate and conditions

Page |5 F. Pathophysiology:

Modifiable factor Women who smoke

Non-modifiable factors Age of gravida: above 35y/o Multiparaty Previous Cesarean section

Pregnancy

Uterine Atrophy

Abnormal vascularization of endometrium

Low Placental implantation (2nd & 3rd trimester)

Implantation in low uterine

Placenta Previa

Total/complete (PP) Early (20-28weeks) Large amount of bleeding

Partial (PP) Between total & marginal

Marginal and Low Lying (PP) Late (37-40weeks)/ in labor Less bleeding

Cervical Dilation

Cover Internal os of Cervix

Disrupted Placental attachment

Uterine Contraction

Malpresentation of fetus

Decreased uterine blood flow

Page |6 Bright red vaginal bleeding

Blood loss

Decreased fetal oxygen supply

Decreased bood volume

Fetal distress IUGR

Hypovolemia Preterm Labor Pallor Decreased kidney perfusion Hypotension

Congenital Anomalies

Cold clammy skin

Decreased capillary refill time Decreased urine output Compensatory mechanism

Tachycardia

Tachypnea

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G. Complications 1. Congenital Anomalies 2. Intrauterine Growth Retardation 3. Maternal Mortality H. Medical Management Maternal stabilization and fetal monitoring Control of blood loss, blood replacement (IVF Therapy) Delivery of viable neonate ( Cesarean section) With fetus of less than 36 weeks gestation, careful observation to determine safety of continuing pregnancy or need for preterm delivery Hospitalization with complete bed rest until 36 weeks gestation with complete placenta previa Oxygen therapy Urinary catheterization I. Nursing Management If continuation of the pregnancy is deemed safe for patient and fetus administer magnesium sulfate as ordered for premature labor Obtain blood samples for complete blood count and blood type and cross matching Institute complete bed rest If the patient and placenta previa is experiencing active bleeding, continuously monitor her blood pressure, pulse rate, respiration, central venous pressure, intake and output, and amount of vaginal bleeding as well as the fetal heart rate and rhythm Assist with application of intermittent or continuous electronic fetal monitoring as indicated by maternal and fetal status. Have oxygen readily available for use should fetal distress occur, as indicated by bradycardia, tachycardia, late or available decelerations, pathologic sinusoidal pattern, unstable baseline, or loss of variability. Administer prescribed IV fluids and blood products. Provide information about labor progress and the condition of the fetus. Prepare the patient and her family for a possible caesarian delivery and the birth of a preterm neonate, and provide thorough instructions for postpartum care. If the fetus less than 36 weeks gestation expect to administer an initial dose of betamethasone: explain that additional doses may be given again in 24 hours and possibly for the next 2 weeks to help mature the neonates lungs. Assure the patient that frequent monitoring and prompt management greatly reduce the risk of neonatal death. Encourage the patient and her family to verbalize their feelings helps them to develop effective coping strategies, and refer them for counseling, if necessary. Anticipate the need for a referral for home care if the patient bleeding ceases and shes to return home in bed rest. During the postpartum period, monitor the patient for signs of early and late postpartum hemorrhage and shock.

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Monitor VS for elevated temperature, pulse, and blood pressure, monitor laboratory results for elevated WBC count, differential shift; check for urine tenderness and malodorous vaginal discharge to detect early signs of infection resulting from exposure of placental tissue. Provide or teach perineal hygiene to decrease the risk of ascending infection. Observe for abnormal fetal heart rate patterns such as loss of variability, decelerations tachycardia to identify fetal distress. Position the patient in side lying position and wedge for support to maximize placental perfusion. Assess fetal movement to evaluate for possible fetal hypoxia. Teach woman to monitor fetal movement to evaluate well being Administer oxygen as ordered to increase oxygenation to mother and fetus.