Placenta previa is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. Placenta previa is a life-threatening maternal bleeding typically necessitates termination of the pregnancy. Maternal prognosis is good if hemorrhage can be controlled; fetal prognosis depends on the gestational age and amount of blood lost. Anemia may be managed by blood transfusion to permit the pregnancy to continue in utero. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum hemorrhage (vaginal bleeding). It affects approximately 0.5% of all labors.
Nursing Care Plans
Nursing care management and treatment of placenta previa is design to assess, control, and restore blood loss, and to deliver a viable infant. Immediate therapy includes starting an IV line using a large bore catheter.
Here are three (3) placenta previa nursing care plans and nursing diagnosis:
- Deficient Fluid Volume
- Decreased Cardiac Output
- Ineffective Tissue Perfusion
- Other Possible Nursing Care Plans
Deficient Fluid Volume
Fluid volume deficit is a state in which an individual is experiencing decreased intravascular, interstitial and/or intracellular fluid. Active blood loss or hemorrhage due to disrupted placental implantation during pregnancy may manifest signs and symptoms of fluid vol. deficient that may later lead to hypovolemic shock and cause maternal and fetal death.
Assessment
Patient may manifest:
- Bleeding episodes (amount, duration)
- Abdomen soft/hard when palpated
- Manifests body weakness
- Low blood pressure
- Increased heart rate
- Decreased respiratory rate
- Fetal heart rate less than normal (120-160 bpm)
- Decreased urine output
- Increased urine concentration
- Pale, cold, clammy skin
Nursing Diagnosis
- Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Planning
- Patient will maintain fluid volume at a functional level possibly evidenced by adequate urinary output and stable vital signs.
| Nursing Interventions | Rationale |
|---|---|
| Establish Rapport | To gain patient’s trust |
| Monitor Vital Signs | To obtain baseline data |
| Assess color, odor, consistency and amount of vaginal bleeding; weigh pads | Provides information about active bleeding versus old blood, tissue loss and degree of blood loss |
| Assess hourly intake and output. | Provides information about maternal and fetal physiologic compensation to blood loss |
| Assess baseline data and note changes. Monitor FHR. | Assessment provides information about possible infection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms. |
| Assess abdomen for tenderness or rigidity- if present, measure abdomen at umbilicus (specify time interval) | Detecting increased in measurement of abdominal girth suggests active abruption |
| Assess SaO2, skin color, temp, moisture, turgor, capillary refill (specify frequency) | Assessment provides information about blood vol., O2 saturation and peripheral perfusion |
| Assess for changes in LOC: note for complaints of thirst or apprehension | To detect signs of cerebral perfusion |
| Provide supplemental O2 as ordered via face mask or nasal cannula @ 10-12 L/min. | Intervention increases available O2 to saturate decreased hemoglobin |
| Initiate IV fluids as ordered (specify fluid type and rate). | For replacement of fluid vol. loss |
| Position Pt. in supine with hips elevated if ordered or left lateral position. | Position decreases pressure on placenta and cervical os. Left lateral position improves placental perfusion |
| Monitor lab. Work as obtained: Hgb & Hct, Rh and type, cross match for 2 units RBCs, urinalysis, etc. Scheduled for ultrasound as ordered. | Lab Work provides information about degree of blood loss; prepares for possible transfusion. Ultrasound provides info about the cause of bleeding |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans related to the care of the pregnant mother and her infant:
- Abruptio Placenta | 3 Care Plan
- Abortion (Termination of Pregnancy) | 8 Care Plans UPDATED!
- Cesarean Birth | 10 Care Plans UPDATED!
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans UPDATED!
- Hyperbilirubinemia (Jaundice) | 4 Care Plans UPDATED!
- Labor Stages, Induced and Augmented Labor | 36 Care Plans UPDATED!
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans UPDATED!
- Postpartum Thrombophlebitis | 5 Care Plans UPDATED!
- Prenatal Hemorrhage | 9 Care Plans UPDATED!
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Preeclampsia and Gestational Hypertension | 6 Care Plans UPDATED!
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 7 Care Plans UPDATED!
- Puerperal & Postpartum Infections | 5 Care Plans UPDATED!