Evidence Based Nursing Research

Running head: EVIDENCE BASED NURSING RESEARCH 1
Evidence Based Nursing Research
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EVIDENCE BASED NURSING RESEARCH 2
Evidence Based Nursing Research
Nurses are the primary caregivers in healthcare facilities and as such, they are supposed
to be well versed with quality management in order to improve their problem solving skills in the
most efficient way in order to improve the patients’ satisfaction and enhance the clinical nursing
work (Walker et al, 2013). In reference to a case study, this paper details the clinical issues that
nurses face when they encounter patients diagnoses with placenta previa and analyses the
possible goals that nurses can achieve in order to reduce maternal morbidity arising from
excessive postpartum bleeding.
Consideration of the Patient’s Situation
Candace Evans, a 42 year old woman is admitted to the operating theater for an elective
lower uterine caesarian section (LUCS) under spinal anesthesia. At 38 weeks of pregnancy,
Evans has been diagnosed with Placenta Previa. This is Miss Candace second pregnancy and she
has not presented any of the previous problems exhibited during her first pregnancy where she
experienced gestational diabetes. However, depression and anxiety were realized following the
second birth. Although the second birth was uneventful, it was estimated that the patient
experienced intraoperative blood loss at 150ml (Swetha, 2016). Most worryingly, it is realized
that the patient’s vaginal pad had soaked blood with clots in it. Also, the patient’s partner seems
anxious and worried to see the patient.
Related Health Information
The diagnosis of placenta previa implies that the infant’s placenta had covered the
patient’s cervix either partially or totally. As such, this was the main cause for the patient’s
excessive bleeding resulting in the loss of an estimated 150ml of blood. The most probable risk

EVIDENCE BASED NURSING RESEARCH 3
factors for this condition in this case were the caesarian delivery and the age of the patient. If the
patient doesn’t receive prompt care and monitoring, more blood could be lost and if the bleeding
persists, the patient might require blood transfusion and intravenous fluids. The elective C-
section was critical in preventing complications for the infant as well as the mother (Cho, 2014).
Although the baby had safely been delivered, this condition severely threatened the health of the
mother if immediate care was not provided to the mother. The patient in this case probably
suffered from postpartum hemorrhage (Fan et al, 2017). In this case the bleeding associated with
the placenta previa occurred after the placenta was extracted and as such, the bleeding started
after the delivery.
Identification of Nursing Problems
The patient exhibited excessive bleeding that was brought about by placenta previa which
presented a significant threat to the health of the mother. This condition is the most common
cause of bleeding especially during the third trimester of pregnancy. Hence, given the 38 week
gestation, it can be noted that the bleeding arose from some factors such as over-sized placenta,
endometrial lesions of uterine body or placental abnormality (Sato et al, 2015). Similarly, other
studies have also indicated that the main causes of this condition emanates from an adhesive
placenta and antenatal bleeding.
Although maternal mortality has significantly reduced over the years, studies have
indicated that antenatal and post natal bleeding are the major current causes of maternal
mortality. In relation the patient, it can be noted that the placenta previa resulted in massive
hemorrhage which could also be subject to the successive caesarian delivery. Also, the bleeding
from the placenta previa can be associated with the placental adhesion which subsequently