Question

A patient presents in the ER status post car accident. She is 37 5/7 weeks pregnant, G1P0. She complains of sharp fundal pain and dark red bleeding. Upon an initial assessment you note the following:

• Moderate amounts of dark red blood has saturated the bed.
• Maternal Vital signs: HR 122, RR20, O2 Sat 97, BP 102/70
• FHR 78
• Her lung sounds are clear and equal
• She has a small laceration on the side of her head from the impact of the crash

Answer the following questions:

1. What condition has this woman presented with?
2. Describe the pathophysiology of this condition.
3. List 3 PRIORITY nursing interventions for this patient. Include rationales.
4. What orders will you anticipate receiving from the physician? Include rationales.

Answer 1

1.As the client has sharp, stabbing pain the women has- Placenta Abruption

2. The pathophysiology-

A. The Placenta has implanted in the correct location.

B. For some unknown reason it's suddenly begins to separate causing bleeding.  

C. This separation could occur late in pregnancy, and accounts for 10% of perinatal death.

Etiological factors

↓

Hemorrhage in decidua basilai's initiate placental separation

↓

Decidual Hematoma leads to degeneration and necrosis of dacidua basilis and adjacent placental parts.

3. Nursing Intervention-

Nursing intervention	Rational
1. Place the women in latera, not supine position	it avoids pressure in Vena cava
2. Monitor maternal Vital signs and Fetal heartsound	it provides baseline data
3. Avoid performing any vaginal or abdominal examination	it prevent further injury to placenta

4. Order by physician-

Physician order	rational
1. Intravenous Therapy- once the woman starts to bleed the physician wouldoorder a large gauge IV cathete.	It replaces the fluid losses.
2. Oxygen inhalation - delivered through face mask, this would prevent fetal anorexia.	It prevents fetal anorexia
3. Fibrionogen determination- this test wouldbe taken several times before birth.	It detect DIC