Primary Nursing Diagnosis

Fluid volume deficit related to blood loss OUTCOMES. Fluid balance; Hydration; Circulation status

INTERVENTIONS. Bleeding reduction; Blood product administration; Intravenous therapy; Shock management

H PLANNING AND IMPLEMENTATION Collaborative

If the fetus is immature (<37 weeks) and the abruption is mild, conservative treatment may be indicated. However, conservative treatment is rare because the benefits of aggressive treatment far outweigh the risk of the rapid deterioration that can result from an abruption. Conservative treatment includes bedrest, tocolytic (inhibition of uterine contractions) therapy, and constant maternal and fetal surveillance. If a vaginal delivery is indicated and no regular contractions are occurring, the physician may choose to infuse oxytocin cautiously in order to induce the labor.

If the patient's condition is more severe, aggressive, expedient, and frequent assessments of blood loss, vital signs, and fetal heart rate pattern and variability are performed. Give lactated Ringer's solution intravenously (IV) via a large-gauge peripheral catheter. At times, two intravenous catheters are needed, especially if a blood transfusion is anticipated and the fluid loss has been great. If there has been an excessive blood loss, blood transfusions and central venous pressure (CVP) monitoring may be ordered. A normal CVP of 10 cm H2O is the goal. CVP readings may indicate fluid volume deficit (low readings) or fluid overload and possible pulmonary edema following treatment (high readings).

If the mother or fetus is in distress, an emergency cesarean section is indicated. If any signs of fetal distress are noted (flat variability, late decelerations, bradycardia, tachycardia), turn the patient to her left side, increase the rate of her IV infusion, administer oxygen via face mask, and notify the physician. If a cesarean section is planned, see that informed consent is obtained in accordance with unit policy, prepare the patient's abdomen for surgery, insert a Foley catheter, administer preopera-tive medications as ordered, and notify the necessary personnel to attend the operation.

18 Abruptio Placentae

After delivery, monitor the degree of bleeding and perform fundal checks frequently. The fundus should be firm, midline, and at or below the level of the umbilicus. Determine the Rh status of the mother; if the patient is Rh-negative and the fetus is Rh-positive with a negative Coombs' test, administer Rho(D) immune globulin (rhoGAM).

Pharmacologic

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