Teaching Plan L&D/OB-GYN - Unit Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health

h Center TEACHING PLAN FOR: SUPPORTIVE DATA: Vaginal Bleeding in Pregnancy

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Bleeding in pregnancy may be life threatening to the mother and fetus. Bleeding must be regarded seriously. This teaching plan addresses the educational needs of the pregnant patient who experiences vaginal bleeding. Patient will maintain pregnancy as long as optimal well being of both mother and fetus is observed.

DESIRED PATIENT OUTCOMES:

ASSESSMENT:

1. Assess patient/family ability to understanding information given, need for hospitalization, and plan of care, as well as complication associated with vaginal bleeding and potential for delivery. 2. Assess patients preferred language for education and care. 3. Assess patient history of bleeding during current pregnancy.

INTERVENTIONS:

1. Initiate Patient and Family Teaching Record Antepartum (HCH-1376) and begin appropriate education based on patients needs. 2. Reinforce teaching by providing Care Notes on abruption, placenta previa, and threatened miscarriage and other written materials when available. 3. Have patient verbalize/demonstrate instructions given to determine patient understanding.

PATIENT EDUCATION:

1. Instruct patient to report: a. Changes in amount and color of bleeding b. Passage of tissue vaginally c. Cramping or contractions d. Severe abdominal pain e. Decreased fetal movements f. Restlessness g. Increased sweating h. Pallor 2. The incident of bleeding in pregnancy has been associated with certain risk factors. a. Chronic maternal health factors such as hypertension, renal disease, SLE, hypo and hyper thyroidism.

Teaching Plan L&D/OB-GYN - Unit Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health Center TEACHING PLAN FOR: Vaginal Bleeding in Pregnancy b. PPROM c. Multiparity d. Polyhydramnios

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e. Drug use including alcohol use, tobacco, cocaine, caffeine f. Previous cesarean section/other uterine surgery g. Acute maternal factors such as infections and trauma h. Uterine fibroids and cervical incompetence i. IUGR j. Advanced maternal age k. Repeated second and third trimester abortions, cervical scarring from lacerations, elective abortions, dilation and curettage

l. Placenta previa m. Abdominal trauma 3. Immediate evaluation of the condition of the fetus and mother provides the key to successful management, If maintenance of the pregnancy is possible, reinforce significance of: a. Maternal and fetal assessments to assure well being or the changing status of the fetus by frequent fetal monitoring and vital signs. b. The need for maintained IV access and possible need for blood transfusion if bleeding is extensive. c. Possible medication administration of steroids, tocolytics and antibiotics. d. Explain to patient the needs for frequent laboratory testing, ultrasound testing and fetal monitoring to assess change in condition. e. Strict/partial bed rest while hospitalized. Limited bathroom privileges are allowed after patient is asymptomatic for a number of days. f. Pericare, after each void. g. Change peripad every one to two hours and after each void with any bleeding. h. Avoid straining with BM. i. The possible need for amniocentesis. 4. Educate patient regarding pending vaginal or cesarean delivery.

Teaching Plan L&D/OB-GYN - Unit Practice Manual John Dempsey Hospital Department of Nursing The University of Connecticut Health Center TEACHING PLAN FOR: CONSULTATION: Vaginal Bleeding in Pregnancy

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1. Arrange for NICU consultation if gestational age (<32weeks) appropriate. 2. Anesthesia consult. 3. Tour of NICU if condition permits. 4. Social service if indicated.

SAFETY/ACTIVITY:

Refer to Falls Risk protocol.

REPORTABLE CONDITIONS:

1. Patient with limited capacity to understand. 2. Patient is non - compliant. 3. Patient has minimal or no support network.

DOCUMENTATION:

1. Initiate the Patient and Family Teaching Record Antepartum (HCH1376). 2. Initiate Standard Care Plan (HCH-952). 3. Document patient response or barriers to instruction. 4. Document on Falls/Skin/Neurological Assessment Sheet (HCH-2224).

APPROVAL: EFFECTIVE DATE: REVISION DATES:

Nursing Standards Committee 3/91 10/91, 3/11, 7/13