Prenatal hemorrhage happens due to certain physiological problems in the early or late stages of pregnancy, each with its own signs and symptoms, which aids in determining a differential diagnosis and in formulating a care plan. This nursing care plan focuses on managing hemorrhage during the prenatal period. Specific interventions are identified to address each physiological problem as indicated.
Nursing Care Plans
Nurse care planning for a client with prenatal hemorrhage include assess maternal/fetal condition, maintain circulatory fluid volume, assist with efforts to nurture the pregnancy, if possible, avoid complications, provide emotional support to the client/couple, and provide knowledge on short- and long-term complications of the hemorrhage.
Here are seven (7) nursing care plans (NCP) for prenatal hemorrhage:
- Ineffective [Uteroplacental] Tissue Perfusion
- Acute Pain
- Deficient Fluid Volume (Isotonic)
- Deficient Knowledge
- Risk for Excess Fluid Volume
- Risk of Maternal Injury
Ineffective [Uteroplacental] Tissue Perfusion
Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.
May be related to
Possibly evidenced by
- Changes in fetal heart rate/activity
- Client will display improved tissue perfusion, as evidenced by fetal heart rate and activity within normal limit and reactive non-stress test.
|Assess maternal physiological circulatory status and blood volume.||An abnormal bleeding episode may lead to complications in pregnancy such as uteroplacental hypovolemia or hypoxia.|
|Auscultate and report FHR; note bradycardia or tachycardia. Note change in hypoactivity or hyperactivity.||Assesses degree of fetal hypoxia. Initial response of a fetus to decreased oxygenation is tachycardia and increased movements. A further deficit will result in bradycardia and decreased activity.|
|Note expected date of birth (EDB) and fundal height.||Provides an estimate for identifying fetal viability.|
|Monitor and record maternal blood loss and uterine contractions.||Excess maternal blood loss compromises placental perfusion. If uterine contractions are accompanied by cervical dilatation, bedrest and medications may not be effective in maintaining the pregnancy.|
|Institute strict bed rest in lateral position.||Relieves pressure on the inferior vena cava and enhances placental circulation and oxygen exchange.|
|Obtain vaginal specimen for alkali denaturation test (APT test), or use Kleihauer-Betke test to determine maternal serum, vaginal blood, or products of gastric lavage.||When vaginal bleeding is present, differentiates maternal from fetal blood in amniotic fluid; provides a rough quantitative estimate of fetal blood loss and indicates implications for fetal oxygen-carrying capacity, and maternal need for Rh immunoglobulin G (RhIgG) injections, once delivery occurs. The Kleihauer-Betke test is more sensitive and quantitatively accurate than the APT test, but is time-consuming and may be impractical if the specimen is sent to an outside laboratory.|
|Carry out/repeat NST, as indicated.||Electronically evaluating the FHR response to fetal movements is useful in determining fetal well-being (reactive test) versus hypoxia (nonreactive).|
|Assist with ultrasonography and amniocentesis. Explain procedures.||Determines fetal maturity and gestational age. Aids in determining viability and realistically predicting outcome|
|Replace maternal fluid/blood losses.||Maintains adequate circulating volume for oxygen transport. Maternal hemorrhage negatively affects uteroplacental oxygen transfer, leading to possible loss of a pregnancy or worsening fetal status. If oxygen deprivation persists, the fetus may exhaust coping mechanisms, and CNS damage/fetal demise can occur.|
|Administer supplemental oxygen to the client.||Increases oxygen available for fetal uptake. The fetus has some inherent capacity to cope with hypoxia in that fetal Hb dissociates (releases oxygen at the cellular level) more rapidly than adult Hb, and the fetal red blood cell count is greater than that of the adult, so fetal oxygen-carrying capacity is increased.|
|Prepare client for appropriate surgical intervention as indicated.||Surgery is necessary if placental separation is severe; or if bleeding is excessive, fetal oxygen deprivation is involved, and vaginal delivery is impossible, as in cases of total placenta previa (a low-lying placenta), where surgery may be indicated to save the life of the fetus.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans