UNIT 3 ASSIGNMENT 3: Prioritizing Needs
Required Reading:
Reading from course material:
· Read .
Assignment to turn in:
Utilizing what you learn about the medical diagnosis of placenta previa and how doulas are able to help with non-medical needs. Identify the non-medical needs for this client as it pertains to their medical diagnosis. Describe how these needs may change from the beginning of the scenario to the end. Use the needs listed, as well as any others you can think of. Use Maslow’s hierarchy of needs and the client’s goals to prioritize the needs. Be sure to include at least one entry for each section of Maslow’s Hierarchy of Needs.
Use this format to answer the question:
Medical diagnosis or treatment (at the beginning):
Possible client goal:
Non-medical need related to medical diagnosis or treatment (use client’s goal and Maslow’s Hierarchy of Needs):
Physiologic Need-
Safety Need-
Esteem Need-
Social-
Medical diagnosis or treatment (in the middle):
Possible client goal:
Non-medical need related to medical diagnosis or treatment (use client’s goal and Maslow’s Hierarchy of Needs):
Physiologic Need-
Safety Need-
Esteem Need-
Social-
Medical diagnosis or treatment (at the end):
Possible client goal:
Non-medical need related to medical diagnosis or treatment (use client’s goal and Maslow’s Hierarchy of Needs):
Physiologic Need-
Safety Need-
Esteem Need-
Social-
Sue Fortson is a 23 year old G-2 P-1 admitted with a known placenta previa.
At 22 weeks gestation, she had some vaginal spotting, prompting an ultrasound evaluation which showed a marginal placenta previa. She was admitted to the hospital for bedrest and observation and the bleeding stopped. She was sent home with instructions for pelvic rest. She did well, without any bleeding, until 28 weeks gestation, when she noticed some additional spotting, apparently provoked by cleaning her house. She was readmitted for bedrest, and had no further bleeding.
After several days of no further bleeding and another ultrasound scan that again showed a marginal placenta previa and a long, thick and closed cervix, she was sent home. Later that day, she experienced bright red bleeding at home and returned to the hospital, where she’s been hospitalized ever since. She is now 33 weeks and 2 days.
During her second hospitalization at 28 weeks, she received betamethasone as steroid treatment to accelerate fetal maturity. This was not repeated as at no time since then has delivery seemed imminent.
Normally, the placenta is attached to the uterus in an area remote from the cervix. Sometimes, the placenta is located in such a way that it covers the cervix. This is called a placenta previa.
There are degrees of placenta previa:
· A complete placenta previa means the entire cervix is covered. This positioning makes it impossible for the fetus to pass through the birth canal without causing maternal hemorrhage. This situation can only be resolved through cesarean section.
· A marginal placenta previa means that only the margin or edge of the placenta is covering the cervix. In this condition, it may be possible to achieve a vaginal delivery if the maternal bleeding is not too great and the fetal head exerts enough pressure on the placenta to push it out of the way and tamponade bleeding which may occur, although usually these patients also deliver by cesarean section.
Clinically, these patients present after 20 weeks with painless vaginal bleeding, usually mild. This contrasts with patients with placental abruption, who usually experience significant pain and contractions. An old rule of thumb is that the first bleed from a placenta previa is not very heavy. For this reason, the first bleed is sometimes called a “sentinel bleed.”
Later episodes of bleeding can be very substantial and very dangerous. This can lead to hypovolemic shock and maternal death. Because a pelvic exam may provoke further bleeding it is important to avoid a vaginal or rectal examination in pregnant women during the second half of their pregnancy unless you are certain there is no placenta previa.
Factors associated with an increased risk of placenta previa include:
· High maternal parity
· Increased maternal age
· Previous cesarean section
· Previous uterine surgery
• Uterine malformations• Use of cocaine or its derivatives• Cigarette smoking• Uterine trauma secondary to surgery
In the case of this patient, she had no predisposing factors.
The usual treatment for a known placenta previa is scheduled cesarean section at 36 weeks after confirmation of fetal pulmonary maturity or accelerated maturity with betamethasone. This point is selected because it is usually the optimum tradeoff between fetal immaturity and heavy maternal bleeding.
In some cases, this timing may need to be altered. For example, this patient has not been stable and has had several bleeding episodes. For that reason, we will aim at intervening at 34 weeks instead of 36 weeks, although we could still change course either way, if her bleeding stabilizes or worsens.
