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HLT54115 Diploma Of Nursing Question: Discuss about the Influence Provision of Intrapartum.     Answer: Introduction: The separations of the premature form of the placenta always begin with the pain of the sharp fundal that are followed by the bleeding from the vagina. The placenta previa generally produces bleeding that is painless. The contractions of the preterm labor are more commonly described to be cramping. The possible form of the most fatal form of the death are the not presented with the sharp form of the fundal pain as they are generally does not cause pain.  The primary form of the therapy goals for any of the patients who are suffering from the preeclamtic is only to prevent them from the seizures during conception. The uses of the magnesium sulphate are only done as it is the therapy of drug that is chosen for the severe form of the preeclampsia and they are used for managing the attempt to prevent any progression to the eclampsia. The magnesium sulfate therapy does not have the primary care goal to decrease the blood pressure that can be due to the decrease in the protein content in the urine that is the reversal of the edema. The Nursing Care Plan For The Patient The complications in the prenatal stages are mostly associated with the multiple pregnancies that mostly include the preterm form of the birth, the maternal form of the hypertension and the abnormalities in the congenital areas of the mother. The fetal form of the nonimmune form of the hydrops occurs only when there is a infection of the clients who are pregnant with the parvovirus (Lowdermilk, Perry & Cashion, 2014). The births of the posterm are generally due to the maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancies. The nurses should always instruct the patient to eat small but frequent number of meals all throughout the day to reduce the incidence of nausea and vomiting. The nurse should also instruct the patient to avoid lying down or to recline at least for 2 hours after eating so as to rise the level of the intake of the beverages that are carbonated. The nurse should also instruct the patient that to have food that can be able to settle in the stomach such as the dry crackers toast, or soda (Lowdermilk, Perry & Cashion, 2014). Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical are associated with a threatened abortion. Strong abdominal cramping is associated with an inevitable abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion. The classic manifestations of abruption placenta are painful dark red vaginal bleeding, “knife-like” abdominal pain, uterine tenderness, contractions, and decreased fetal movement (Cole et al., 2015). Painless bright red vaginal bleeding is the clinical manifestation of placenta previa. Generalized vasospasm is the clinical manifestation of preeclampsia and not of abruptio placenta. The client has advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for pregnancy loss. Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks’ gestation is losing this pregnancy. A nurse should closely monitor the client’s vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture. Beta-hCG level is monitored to diagnose an ectopic pregnancy or impending abortion. Monitoring the mass with transvaginal ultrasound and determining the size of the mass are done for diagnosing an ectopic pregnancy. Monitoring of the FHR does not help to identify hypovolemic shock.   The Nursing Strategies That Are Applied There are always the threat of massive hemorrhage and the pattern of the delivery in the women who is going through the placenta previa. The document has the adequate form of the preparation that has the higher level of the care with including the transfers. Homeostatis may occur due to several reasons (McCafferty, 2014). It may be established due to the oversewing of the implantation site of the placenta, bilateral uterine artery ligation and internal iliac artery ligation. The diffuse form of the bleeding often occurs at the site of the implantation within the lower form of the uterine segments after the delivery. The activation of the massive form of the transfusion are the protocol that may be warranted that is dependent on the situation. However, it has been seen that when there is a significant occurrence of bleeding, there are rapid replacement for the products of the blood that is of the utmost priority. In these cases, the activation of the massive transfusion protocols they are allowing for the stabilization of the hemodynamic status of the patients by the rapid form of the supply and the infusion of the products of the blood (McCafferty, 2014). The patient should be assessed in the labor and the delivery unit and the focus should always be on the stability of the maternal hemodynamic and their well-being. The evaluations are to be initiated with a close observation to the major signs and the initiation of the monitoring the fetal electronically. In accordance to the case study, it has been seen that the patient is going through a heavy blood loss and it is due to the obstetric hemorrhage as one of the major causes of maternal death. Therefore, it is very necessary for the nurses to record the type, site and the amount of blood loss (Gusmão et al., 2016). The nurses should count the weight of the parineal pads and if it is possible, they need to save the clotting of the blood that can be only evaluated by the physicians. The correct amount of the loss of blood and the presence of the level of the blood clotting can help to determine the appropriate amount of the replacement that is needed for the patients (Gusmão et al., 2016). The assessment of the location of the uterus and the degree to which that are contractible of the uterus. Therefore, the immediate form of the remedy that can be given by the nurses will be to massage the boggy form of the uterus using one hand and by placing the second hand above the symphysis pubis. The degree of the contractibility of the uterus will be helpful for measuring the status of the loss of the blood. Just by placing the hand just above the symphysis pubis will be possible for preventing the possible form of the uterine inversions that is done during the massage (Green, 2015). The Possible Outcomes The postpartum hemorrhage is one of the rarest cases when the patient is in the general or the acute form of care for the surgeon that may be called as a emergency basis for the labor and the delivery. This is a situation where the time is very limited and the stakes are very high. One of the most significant form of the postpartum hemorrhage are recognized as the resuscitation that is performed in the parallel form of the efforts of the diagnostic efforts. The fluids are to be replaced with the goals that are matched by all the previous form of the losses that are seen within the first hour (O’Connor et al., 2015). The rate is then being titrated to provide the maintenance of the fluids that are to be continued for the losses that are so appropriate for the vital signs that are to be maintained. However, it is prudent to the limit that are more than 2L of the crystalloids, 1.5L of colloid and 2 units of the type of the O negative blood groups that are provided by the cross matched blood to the patients. The more accurate form of assessments that has the volume for the loss that can be assessed by calculating the volume of the blood of the patients. However, if the bleeding persists then with the loss of the blood is greater than 40% of the estimated form of the volume of the blood of the patient that are needed to be transfused to the patient.   References Cole, J., Jones, T., Shaughnessy, E., Chadwick, S., Munson, D., & Moldenhauer, J. (2015). Multidisciplinary Perinatal Palliative Care Plan for a Pregnant Woman Carrying a Fetus with Trisomy?13 and Her Family. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44(s1). Green, C. J. (2015). Maternal newborn nursing care plans. Jones & Bartlett Publishers. Gusmão, N. V. S., do Nascimento Souza, Z. C. S., & de Camargo Fonseca, M. C. (2016). Atendimento às gestantes e puérperas pelo serviço de atendimento móvel de urgência/Care provided to pregnant women and puerperal mothers by the mobile emergency care service. Ciência, Cuidado e Saúde, 15(1), 11-18. Lowdermilk, D. L., Perry, S. E., & Cashion, M. C. (2014). Maternity Nursing-Revised Reprint-E-Boo Mahadevan, U., & Matro, R. (2015). Care of the pregnant patient with inflammatory bowel disease. Obstetrics & Gynecology, 126(2), 401-412. McCafferty, K. L. (2014). Understanding the factors that influence the provision of intrapartum nursing care within rural settings. University of Nebraska Medical Center. O’Connor, A., Lewis, L., McLaurin, R., & Barnett, L. (2015). Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective. Midwifery, 31(8), 793-797. Oluoch, D. A., Mwangome, N., Kemp, B., Seale, A. C., Koech, A., Papageorghiou, A. T., … & Jones, C. O. (2015). “You cannot know if it’sa baby or not a baby”: uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya. BMC pregnancy and childbirth, 15(1), 127. Qi, M., Chang, E., Tou, K., Lian, Q., Wen, D., Khoo, C. K., & Tan, K. H. (2016). Placental massive perivillous fibrinoid deposition is associated with adverse pregnancy outcomes: a clinicopathological study of 12 cases. Case Reports in Perinatal Medicine, 5(1), 35-39. Sumigama, S., Sugiyama, C., Kotani, T., Hayakawa, H., Inoue, A., Mano, Y., … & Okamoto, T. (2014). Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: a case–control study. BJOG: An International Journal of Obstetrics & Gynaecology, 121(7), 866-875.

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