NRSG370 Case Study: Evidence-Based Care for Placenta Previa Patient

This case study analyzes the nursing care provided to a 42-year-old woman, Candace Evans, diagnosed with placenta previa at 38 weeks of gestation, who underwent an elective lower uterine caesarean section (LUCS). The study identifies key nursing problems, including excessive bleeding and the patient's psychological state (anxiety and depression). It proposes goals of nursing care centered around a feed-forward control nursing model, emphasizing patient examination, monitoring of vaginal bleeding, medical observation, and psychological consultation. The discussion elaborates on the implementation of these strategies, including body positioning, explaining the prognosis to the patient, checking blood volume, and preparing for potential complications like emergency hysterectomy. The evaluation highlights the importance of these strategies in improving patient well-being, reducing maternal morbidity, and enhancing patient satisfaction. The reflection underscores the role of nurses in making prompt decisions to reduce childbirth complications and maternal deaths, advocating for patient-centered care tailored to individual needs.

Running head: EVIDENCE BASED NURSING RESEARCH 1
Evidence Based Nursing Research
Student’s Name
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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

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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

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exacerbated the postpartum hemorrhage thereby subjecting the patient to dangerous health
problems that can be fatal (Kok et al, 2013).
Another problem arising from this case was psychological state of the patient since the
patient exhibited anxiety and depression. Ideally, pregnant women or mothers diagnosed with
placenta previa are in most cases emotionally unstable and are usually unaware of the
expectations during the treatment process (Scott & Holleran, 2013). Moreover, they are in a state
in which they cannot be able to judge their conditions accurately thereby necessitating more care
and help from the nurses.
Goals of Nursing Care
The primary mode of action to take would be to employ a feed forward control nursing
model. This mode of treatment aims to examine, monitor and report on the patient’s vitals in
order to form a basis for the best action to take in order to stop the bleeding. Alternatively, since
the bleeding most likely occurred after the delivery, focus should be put on predicting the time
that the bleeding should start (Zhu et al, 2013). Unlike antenatal bleeding associated with
placenta previa, the time of postnatal bleeding is predictable since placental adhesion can easily
be determined during pregnancy. Also, the psychological well-being of the patient needs to be
prioritized given that the patient could be traumatized by her condition since she is not fully
aware of the causes of excessive bleeding.
Discussion of the Nursing Care for the Patient
Feed forward control nursing model is critical in the provision of care for the patient and
ultimately ensuring that the bleeding has been managed thereby putting the patient out of danger.
This model ideally sets forth practical measures that improve the patient care provided by nurses.

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Precisely, this model comprises of patient examination, body positioning, monitoring vaginal
bleeding and reporting, medical observation and psychological consultation (Zhu et al, 2013). In
this mode of treatment, the patient should be encouraged to rest on their beds so as to allow for
improvement of blood circulation in the placenta. In such a case, nurses should recommend
lateral positioning for purposes of reducing umbilical cord compression or to prevent the inferior
vena cava from being compressed by the uterine (Walker et al, 2013). Body examination and,
monitoring and recording vaginal bleeding time is also essential.
Nurses should strive to explain the prognosis of the condition to the patient in order to
enable them understand the cause of their excessive bleeding as well as reduce the anxiety (Cho,
2014). The blood volume of the patient should be checked in order to establish whether there is
need to undertake blood transfusion. Notably, monitoring and reporting should enable nurses to
sustain the patient’s normal blood volume as well as establish grounds for performing blood
transfusion.
Focus can also be put on determining the time of bleeding and most importantly prepare
the blood, fluids and man power to prevent the bleeding complications. As evidence reveal,
previous C-section deliveries can be taken as key indicators for bleeding complications during
successive deliveries. Likewise, postpartum blood loss are usually higher in the second planned
caesarian section deliveries due to placenta adhesion (Hasegawa et al, 2012). The preparation of
blood, fluids and manpower is also crucial especial when there is needed to perform high
sensitive surgeries such as emergency hysterectomy. The need for such a procedure may arise as
a result of excessive loss of blood after surgical procedures or uterine rupture (Radnia et al,
2017). Although the risks associated with this type of surgery are relatively high, it may be
necessitated in order to save the life of the patient and in such cases, success rates of these

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surgeries have often been determined by the preparedness of nurses, physicians as well as
midwives (Kollmann et al, 2016). Hence, it is the initial bleeding prediction that can facilitate
nurses’ prompt decision making skills that can save the lives of patients such as Miss Candace.
Psychological counseling should also be performed in order to understand the patient’s
emotional state. This counseling is in relation the patient’s nervousness, anxiety or depression
that is exhibited by the patient as well as the patient’s partner (Kamara et al, 2013). Given the
patient’s emotional state in relation the diagnosed conditions, nurses should strive to explain to
the patients their conditions in a bid to calm them and enable them feel more comfortable.
Evaluation of Nursing Care Strategies
The aforementioned strategies are focused on improving the patient’s well-being by
specifically reducing the risk of maternal morbidity and catering for the emotional status of the
patient. The forward control nursing model enhances the level of services that nurses provide to
patients and subsequently improves the patient satisfaction towards the clinical practice. This is
mainly so because the patient is allowed more comfort, allocated continuous care dictated by the
patient’s own needs and is provided with a favorable environment that speeds up the recovery
process. Also psychological counseling ensured that the patient’s expected outcomes coincided
with the treatment plans that were set in place (Scott & Holleran, 2013).
Reflection on the Person’s Outcomes
The encounter with this patient shades light on the importance of nurses in providing
first-line care to patients. In such cases, the ability of nurses to make prompt decisions is critical
towards reducing childbirth complications and most worryingly maternal deaths. Undertaking
the above mentioned set of action plans could prove to be the key towards utilizing evidence

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based practices in clinical work. Consequently, the applications of such practices improves
nurses’ problem solving skills and their expertise in resolving some of the most challenging
situations in their work domain (Fan et al, 2017). Additionally, the applied clinical practice can
enable nurses to understand the need for developing patient centered care that is specifically
tailored to meet the needs of patients who they tend to.
Conclusion
For a patient diagnosed with placenta previa in her third trimester of pregnancy, nurses
need to look out for the possible causes of the excessive bleeding which is most likely to arise
from postpartum hemorrhage. In such cases, the nursing goals need to focus on reducing the risk
of maternal bleeding and ensuring that the patient is in her rights state of mind to understand her
condition. To achieve such objectives, nurses need to conduct a feed-forward control nursing
model, attempt to predict the time of bleeding and undertake psychological counseling.

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