- Decreased Cardiac Output Related to Haemorrhaging and Vaginal bleeding as evidenced by Hypotension and decreased peripheral pulses
- Deficient Fluid Volume related to disrupted placental implantation and Hypovolemia as evidenced by Alteration in haemoglobin and haematocrit, Vaginal bleeding
- Impaired Physical Mobility related to activity restrictions and increased risk for bleeding as evidenced by medical protocol requiring reduced activity
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbal reports from the patient -Fatigue -Restlessness Objective data: -Bradycardia -Tachycardia -Hypotension -Fatigue -ECG changes -Cyanosis -Pallor -Decreased peripheral pulses -Prolonged capillary refill -Restlessness/anxiety | Decreased Cardiac Output Related to Haemorrhaging and Vaginal bleeding as evidenced by Hypotension and decreased peripheral pulses | Patient will exhibit vital signs within normal limits. Patient will remain free from complications from decreased cardiac output, like poor tissue perfusion, organ failure, and shock. | 1. Prepare for inpatient admission. Patients who are unstable with three or more bleeding episodes are recommended to remain hospitalized until delivery. Patients with one or two bleeding episodes may be discharged, but only if they can adhere to treatment guidelines and are in close proximity to a hospital. 2. Administer medications to prepare for delivery. Magnesium sulfate offers neuroprotection for fetuses at <32 weeks gestation when delivery is imminent but not urgent. Corticosteroids are also administered when bleeding is present to support fetal lung maturity. 3. Administer blood transfusions as indicated. Decreased cardiac output in patients with placenta previa is typically caused by active bleeding. Prompt blood transfusions can correct circulating blood volume and increase cardiac output, preventing fetal and maternal complications. 4. Provide a quiet and calm environment. Bleeding while pregnant can cause intense anxiety in the pregnant patient. A calm and quiet environment relaxes the patient and reduces the release of stress-related catecholamines, which cause vasoconstriction, increased myocardial workload, and alterations in cardiac output. 5. Assist with surgical interventions as needed. If hemorrhaging occurs, surgical interventions such as ligation of vessels, compression sutures, or balloon tamponade are necessary to control bleeding and preserve cardiac output. A hysterectomy may be necessary to prevent severe hypovolemia and hypoxia. | Patient exhibited vital signs within normal limits. Patient remained free from complications from decreased cardiac output, like poor tissue perfusion, organ failure, and shock. |
| Subjective data: Verbal reports from the patient about dryness Objective data: -Decreased blood pressure -Decreased pulse pressure -Altered mental status -Increased heart rate -Alteration in haemoglobin and haematocrit -Vaginal bleeding | Deficient Fluid Volume related to disrupted placental implantation and Hypovolemia as evidenced by Alteration in haemoglobin and haematocrit, Vaginal bleeding | Patient will maintain normal fluid status, as evidenced by acceptable vital signs and adequate urinary output. Patient will adhere to recommendations on limiting exercise and exertion to prevent disrupting the placenta | 1. Monitor the patient’s intake and output. Monitoring the patient’s intake and output is vital in determining the patient’s fluid status and adequate blood volume perfusing the patient’s organs. 2. Quantify blood loss. Measuring blood loss visually on soaked towels, pads, or gauze is difficult. Attempt to collect blood in graduated containers or measure the weight of bloody materials subtracted from their weight when dry. This weight in grams is approximately the volume of blood in mL. If possible, account for other sources of fluid loss, like amniotic fluid, irrigation fluid, or urine. 3. Monitor the fetal heart rate and contractions continuously. Deficient fluid and blood volume can negatively affect and compromise fetal health. Bleeding from placenta previa can cause fetal hypoxia due to inadequate uteroplacental perfusion. 4. Administer IV fluids or blood products as indicated. To ensure adequate fluid circulation, administer intravenous crystalloid fluids or blood products as indicated to allow prompt fluid replacement in cases of active bleeding. 5. Administer oxytocin. In the postpartum phase, oxytocin may be administered to control heavy bleeding, as this medication causes the uterus to contract. | Patient maintained normal fluid status, as evidenced by acceptable vital signs and adequate urinary output. Patient adhered to recommendations on limiting exercise and exertion to prevent disrupting the placenta |
Subjective data: Expression of pain and discomfort with movement Refusal to move Objective data: -Limited range of motion -Uncoordinated movements -Poor balance -Inability to turn in bed, transfer, or ambulate -Decreased muscle strength | Impaired Physical Mobility related to activity restrictions and increased risk for bleeding as evidenced by medical protocol requiring reduced activity | Patient will verbalize understanding and adhere to the prescribed activity restrictions. Patient will prevent loss of muscle strength and endurance during bed rest. | 1. Educate on the importance of reduced activity. Reduced activity places less pressure on the cervix and may help the placenta function better to deliver nutrients and oxygen to the fetus. 2. Instruct on specific restrictions. Complete bed rest is often not required. If it is, teach the mother that they should only partake in minimal activities such as walking to the bathroom, sitting at a desk, and standing or walking for less than 20 minutes. 3. Educate on other activities to maintain muscle strength. Patients can usually partake in stretching of the extremities while in bed or other activities that promote circulation. Always discuss with a doctor first. 4. Left side-lying is recommended. Lying on the left side is generally recommended during pregnancy to maximize blood flow to the uterus. | Patient verbalized understanding and adhered to the prescribed activity restrictions. Patient prevented from loss of muscle strength and endurance during bed rest. |