Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption

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Pathophysiology

Abruptio placentae, or placental abruption, is when the placenta partially or completely detaches prematurely from the uterus, causing a risk for hemorrhage. This is most often seen at 24-26 weeks’ gestation and is considered a serious complication. In mild cases, the patient may remain on restricted activity or bed rest for the duration of the pregnancy, but in more severe cases where there is maternal or fetal compromise, delivery is required. While placental abruption generally happens suddenly, chronic abruption may occur in which there is a small separation that causes slow bleeding behind the placenta.

Etiology

Etiology is generally unknown, but risk factors include abdominal trauma, vascular disorders, hypertension (chronic or gestational), PROM or other rapid loss of amniotic fluid, infection, prior history of placental abruption, advanced maternal age (>35 yrs old) and maternal use of tobacco or cocaine. Complications of abruptio placentae include fetal growth restriction, distress or death, maternal blood loss and shock, blood clotting issues (DIC) and maternal kidney and organ failure.

Desired Outcome

Patient will have no or minimal bleeding; pain will be controlled; fetus will show no signs of distress.

Abruptio Placentae / Placental abruption Nursing Care Plan

Subjective Data:

  • Abdominal pain
  • Uterine tenderness 
  • Back pain
  • Constant uterine contractions

Objective Data:

  • Vaginal bleeding
  • Back-to-back uterine contractions 
  • Firmness of uterus on palpation 
  • Advanced abruption and severe blood loss may lead to shock
    • Tachycardia
    • Hypotension

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess and monitor vaginal bleeding Excessive bleeding may result in shock. Amount of obvious blood may not fully indicate severity due to possible internal bleeding
Obtain history from patient Determine time bleeding began, any history of pregnancy complications or abdominal/uterine trauma
Place patient on bed rest in lateral position This position helps avoid pressure on the vena cava to avoid decreased cardiac output
Initiate IV access with large bore line IV fluids will be given to manage hypovolemia and blood transfusion may be required
Assess abdomen for uterine tenderness and contractions Uterus may be tender upon palpation, tense and rigid.

Fundal massage may help to slow bleeding from uterine wall.

Monitor maternal vitals for signs of shock Watch for signs of hypovolemia to include tachycardia, tachypnea and hypotension
Place and observe external fetal monitoring for signs of fetal distress This allows you to monitor fetal heart rate and contractions to observe for variability and responsiveness of the fetal heart rate. A lack of variability or decelerations indicate fetal distress.
Assess and manage pain Massage

Guided imagery

Cool compresses to the forehead

Deep breathing techniques

 

Abdominal, back and uterine pain may accompany bleeding and at times may be severe, especially with contractions.

Provide alternative options for pain relief if able

Administer medications Corticosteroids

Analgesics as appropriate

Oxytocin

 

In addition to IV fluids, corticosteroids may be given to speed up fetal lung development if delivery is necessary.

Oxytocin may be given after delivery to decrease hemorrhage.

Provide patient education Help patient to feel more informed and lessen anxiety and stress

Writing a Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption

A Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

  • https://my.clevelandclinic.org/health/diseases/9435-placental-abruption
  • https://medlineplus.gov/ency/patientinstructions/000605.htm
  • https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/placental-abruption/
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Transcript

Hi everyone, today, we’re going to be creating a nursing care plan for abruptio placentae or placental abruption. So, let’s get started. First, we’re going to be going over the pathophysiology. So abruptio placentae or placental abruption is when the placenta partially or completely detaches prematurely from the uterus. Nursing considerations. We want to assess vaginal bleeding, bedrest, managing pain, administering medications, and fetal monitoring Desired outcomes: the patient will have no, or minimal bleeding, and pain will be controlled. Fetus will show no signs of his distress. And so here we have an image to show. So, you’re going to see all this bleeding all right here, because it’s separated from the uterus right here. And you can see over here, there’s this internal bleeding here and how it’s separated there from the uterus. 

So now we’re going to go over the care plan. We’re going to be writing down some subjective data and some objective data. So, what are we going to see with patients? They are going to have some abdominal pain. They’re going to have some uterine tenderness, possibly some back pain. Some objective data: they’re going to have some vaginal bleeding and some firmness of the uterus. So constant uterine contractions are another thing that these patients may have or an advanced abruption and severe loss. It may lead to tachycardia and hypotension. 

So, interventions, we want to make sure we’re going to assess and monitor vaginal bleeding, the maternal vital signs. We also want to make sure we’re getting a patient history. Excessive bleeding may result in shock. So, the amount of obvious blood may not fully indicate the severity due to possible internal bleeding. We want to watch for signs of hypovolemia to tachycardia, and hypotension. We want to determine time bleeding began and any history of pregnancy complications or abdominal uterine trauma that the mom may have. We also want to make sure we’re placing the patient on bedrest in a lateral position. So, we want to do bedrest and we want to make sure it’s lateral positioning. This position’s going to help avoid pressure on the vena cava to avoid any sort of decreased cardiac output. That is why we want them in the lateral position. We also want to make sure that we initiate any sort of IV access with a large bore line. We’re going to want to make sure we’re giving IV fluids and able to manage the hypovolemia and possibly give a blood transfusion. We want to make sure we’re assessing the abdomen for uterine tenderness and contractions. So, the abdomen we’re going to be assessing. The uterus may be tender upon palpation and tense and rigid. So, a massage may help to slow bleeding from the uterine wall. And we’re going to place and observe external fetal monitoring for signs of fetal distress. So, we’re going to want to make sure that we’re doing fetal monitoring. This allows you to monitor the fetal heart rate and contractions to observe for the variability and responsiveness of the fetal heart rate. A lack of variability or deceleration will indicate fetal distress. We want to make sure that we’re assessing and managing pain So we can do nonpharmacological: massage, guided imagery, cool compresses. Abdominal, back, and uterine pain can all accompany bleeding. And at times it may be severe, especially with contractions. So, you want to make sure we’re providing any sort of alternative options for pain relief, if available. Otherwise, you may end up giving them some by mouth pain medication. So other medications that we may be giving the patient corticosteroids, analgesics for the pain, and oxytocin. So, in addition to IV fluids, corticosteroids may be given to speed up the fetal lung development. If delivery is necessary oxytocin to is given after delivery to decrease hemorrhage. 

Alright, we’re going to move on to the key points. So, the placenta partially or completely will detach prematurely from the uterus. Risk factors will include abdominal trauma, vascular disorders, hypertension, and advanced maternal age. Some subjective and objective data that you’re going to see in these patients: they’ll complain of abdominal pain, uterine tenderness, bleeding, back-to-back uterine contractions, and firmness of the uterus. We want to make sure we’re assessing for that vaginal bleeding, getting a proper history, abdominal tenderness, fetal monitoring, and managing the pain. We want to make sure we’re administering the medications as needed, making sure we’re promoting bedrest. And there we have that completed care plan.

You guys did amazing. We love you guys. Go out, be your best self today and as always happy nursing.

 

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