A patient with placenta previa is experiencing increased vaginal bleeding, lower abdominal pain, and signs of hypovolemic shock. The healthcare team is preparing for an expedited cesarean delivery. What is the nurse's priority intervention to address the patient's current condition?

A) Administer IV fluids and monitor vital signs closely.

B) Prepare the patient for immediate blood transfusion.

C) Educate the patient about the cesarean delivery procedure.

D) Apply continuous external fetal monitoring.

A patient with placenta previa is experiencing increased vaginal bleeding and signs of hypovolemic shock. What is the nurse's priority intervention at this time?

A) Increase the rate of the intravenous fluid infusion

B) Administer oxygen via nasal cannula at 2 L/min

C) Prepare the patient for an emergency cesarean section

D) Monitor fetal heart rate every 5 minutes

A patient with suspected placental abruption is being prepared for an emergency cesarean section. During preoperative preparation, the nurse notes the patient has severe abdominal pain, tachycardia, hypotension, and a low hemoglobin level. What is the nurse's priority action to stabilize the patient?

A) Administer intravenous fluids aggressively to address hypovolemia.

B) Position the patient in a left lateral position to improve uteroplacental circulation.

C) Prepare for immediate blood transfusion to correct anemia.

D) Provide supplemental oxygen to improve fetal oxygenation.

A patient with placenta previa and suspected placental abruption is experiencing severe abdominal pain, tachycardia, hypotension, and fetal distress. What is the priority nursing intervention to address the patient's condition?

C) Increase intravenous fluid administration rate

A) Administer oxygen via face mask to the patient

B) Prepare for an emergency cesarean delivery

C) Increase intravenous fluid administration rate

D) Perform a complete blood count to assess hemoglobin levels

A patient is undergoing a cesarean section due to suspected placental abruption and is experiencing hemodynamic instability. The healthcare team is preparing to manage potential complications. Which of the following interventions should the nurse prioritize to address the patient's current condition?

C) Assist the anesthesiology team in titrating medications to stabilize blood pressure

A) Administer oxygen via face mask to improve fetal oxygenation

B) Prepare for neonatal resuscitation and coordinate with the neonatology team

C) Assist the anesthesiology team in titrating medications to stabilize blood pressure

D) Monitor maternal urine output to assess renal perfusion

A nurse is caring for a patient with suspected placental abruption who is being prepared for an emergency cesarean section. The patient's vital signs reveal a heart rate of 132 bpm and blood pressure of 110/75 mmHg. Which nursing intervention is most critical at this time to ensure the patient's stability?

C) Prepare for immediate blood transfusion

A) Administer oxygen via non-rebreather mask

B) Elevate the patient's legs to improve blood flow

C) Prepare for immediate blood transfusion

D) Insert a Foley catheter to monitor urine output

A nurse is caring for a postpartum patient who underwent an emergency cesarean section due to severe hemorrhage and is now exhibiting signs of disseminated intravascular coagulation (DIC). Which nursing intervention should be prioritized to address the patient's current condition?

D) Facilitate the administration of blood products as ordered.

A) Monitor urine output hourly to assess renal perfusion.

B) Administer prescribed antibiotics to prevent infection.

C) Prepare for potential intubation to secure airway patency.

D) Facilitate the administration of blood products as ordered.

A nurse is caring for a patient who has undergone an emergency cesarean section complicated by significant hemorrhage and suspected disseminated intravascular coagulation (DIC). The nurse receives the results of the coagulation panel showing prolonged PT and aPTT, as well as low fibrinogen levels. What is the nurse's priority action in collaboration with the healthcare team?

B) Prepare to administer fresh frozen plasma and cryoprecipitate

A) Administer intravenous fluids to maintain blood pressure

B) Prepare to administer fresh frozen plasma and cryoprecipitate

C) Monitor the patient's urinary output closely

D) Notify the patient's family about the current situation

A postpartum patient in the immediate postoperative period presents with a heart rate of 120 bpm, blood pressure of 100/65 mmHg, respiratory rate of 24 breaths per minute, and hemoglobin level of 7.2 g/dL. Which nursing intervention should be prioritized to address the patient's current condition?

C) Prepare for the administration of blood transfusion.

A) Monitor vital signs every 4 hours.

B) Administer supplemental oxygen as prescribed.

C) Prepare for the administration of blood transfusion.

D) Encourage early ambulation to prevent thrombosis.

A postpartum patient is being monitored in the immediate postoperative period following a significant hemorrhage. Her vital signs are as follows: blood pressure 100/65 mmHg, heart rate 120 bpm, respiratory rate 24 breaths per minute. She reports mild dyspnea, and lab results indicate a hemoglobin level of 7.2 g/dL. Which of the following nursing interventions is the most priority at this time?

B) Initiate an immediate transfusion of packed red blood cells

A) Administer supplemental oxygen to improve oxygenation

B) Initiate an immediate transfusion of packed red blood cells

C) Encourage the patient to ambulate to prevent deep vein thrombosis

D) Educate the patient about the signs of postpartum depression

Placenta Previa - Nursing Case Study

Pathophysiology

• Primary mechanism: Placenta previa occurs when the placenta implants abnormally low in the uterus, covering the cervical os, either partially or completely. This abnormal placement is crucial because it interferes with the normal separation process during labor, leading to potential bleeding.

• Secondary mechanism: As the lower uterine segment thins in preparation for labor, the attached placenta is unable to stretch adequately, which can cause premature placental detachment and significant maternal hemorrhage, risking both maternal and fetal health.

• Key complication: The main complication of placenta previa is antepartum hemorrhage, which may necessitate preterm delivery and increase the risk of postpartum hemorrhage, making timely diagnosis and management critical for patient safety.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Previous cesarean section, hypertension

• Current medications: Labetalol, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Vaginal bleeding in the third trimester

• Key symptoms: Lower abdominal pain, lightheadedness, intermittent contractions

• Vital signs: Blood pressure 145/95 mmHg, heart rate 105 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

Change in Patient Status:

During a routine monitoring session, the patient's condition began to evolve, necessitating close observation and re-evaluation by the healthcare team. The vaginal bleeding intensified, becoming more frequent and heavier, prompting immediate concern for potential acute blood loss. The patient reported increased lower abdominal pain, which was described as more intense and persistent than before. Her vital signs showed further instability; her heart rate increased to 120 bpm, and her blood pressure dropped to 130/85 mmHg, indicating possible compensatory mechanisms due to blood loss. Her respiratory rate remained stable at 22 breaths per minute, but she appeared increasingly pale and clammy, suggesting the onset of hypovolemic shock.

In response to these changes, additional diagnostic assessments were swiftly conducted. A bedside ultrasound confirmed that the placenta was still covering the cervical os, ruling out any possibility of vaginal delivery and reinforcing the need for a cesarean section. Laboratory results revealed a hemoglobin level of 9 g/dL, down from the previous 11 g/dL, indicating a drop due to the ongoing hemorrhage. The fetal heart rate monitoring indicated a baseline tachycardia at 170 bpm, with occasional late decelerations, raising concerns about fetal compromise.

Given these developments, the interdisciplinary team, including obstetricians and anesthesiologists, prepared for an expedited cesarean delivery to address the emergent situation. The goal was to prevent further maternal and fetal deterioration while managing the risks associated with preterm delivery. This critical juncture required careful coordination to ensure maternal stabilization and optimal neonatal outcomes, highlighting the importance of timely intervention in cases of placenta previa with complications.

Section 2

As the decision for an expedited cesarean delivery was underway, the patient's condition continued to evolve, presenting new complications that required immediate attention. During the preoperative preparation, the patient experienced a sudden episode of severe abdominal pain, described as sharp and unrelenting. This was accompanied by an increase in her heart rate to 130 bpm, while her blood pressure further declined to 115/78 mmHg, suggesting escalating hemodynamic instability. The increased abdominal pain raised concerns of potential uterine rupture or placental abruption, complications that could severely impact both maternal and fetal health.

New diagnostic results from a repeat ultrasound revealed no signs of uterine rupture, but there was evidence of a possible abruption, as indicated by a retroplacental clot. The fetal heart rate pattern became more concerning, with sustained tachycardia at 180 bpm and recurrent late decelerations, pointing to significant fetal distress. The patient's hemoglobin level dropped further to 8.5 g/dL, underscoring the urgency of addressing the blood loss and stabilizing her hemodynamic status.

In light of these developments, the healthcare team intensified their efforts to stabilize the patient preoperatively. Intravenous fluids were administered more aggressively to counteract hypovolemia, and cross-matched blood was prepared for potential transfusion. The anesthesiology team, aware of the heightened risk factors, planned for a rapid-sequence induction to minimize time to delivery. These coordinated interventions aimed to swiftly transition the patient to the operating room, emphasizing the critical need for efficient teamwork and clinical reasoning in managing the complexities of placenta previa with concurrent complications. This pivotal moment in the patient's care trajectory underscored the delicate balance of ensuring maternal stabilization while prioritizing fetal well-being.

Section 3

As the patient was swiftly transitioned to the operating room, the healthcare team remained vigilant, continuously monitoring both maternal and fetal statuses. The patient's heart rate remained elevated at 132 bpm, and her blood pressure showed further signs of instability, dropping to 110/75 mmHg despite the aggressive fluid resuscitation. These findings highlighted the ongoing challenge of managing her hemodynamic instability, likely exacerbated by the concealed blood loss associated with the suspected placental abruption.

In the operating room, the anesthesiology team initiated the rapid-sequence induction, carefully titrating medications to avoid further compromise of the patient's blood pressure. In response to the preoperative assessment, additional cross-matched units of blood were prepared, anticipating the potential need for transfusion post-delivery, given the patient's declining hemoglobin levels and the likelihood of further hemorrhage during the cesarean section.

Once the surgery commenced, the obstetric team quickly confirmed the presence of a significant retroplacental hematoma, correlating with the ultrasound findings of placental abruption. As the neonatology team prepared for the delivery of the distressed fetus, the obstetricians encountered more extensive bleeding than initially anticipated, requiring immediate intervention to control the hemorrhage. This situation necessitated a coordinated effort between the surgical, anesthesiology, and nursing teams to maintain hemodynamic stability while ensuring the swift and safe delivery of the baby. The unfolding scenario underscored the critical importance of clinical reasoning and adaptability in managing the complexities of placenta previa with associated complications, as the team worked diligently to stabilize both mother and child in the face of evolving challenges.

Section 4

As the cesarean section progressed, the surgical team encountered a sudden increase in maternal bleeding, despite their efforts to control the hemorrhage from the retroplacental hematoma. The patient's blood pressure dropped further to 90/60 mmHg, and her heart rate escalated to 145 bpm, indicating worsening hemodynamic instability. The obstetricians, aware of the potential for disseminated intravascular coagulation (DIC) in the context of significant blood loss and tissue trauma, quickly requested a stat coagulation panel and fibrinogen levels. The nursing team efficiently coordinated with the laboratory to expedite these tests, while the anesthesiology team adjusted their fluid and vasopressor management strategies to stabilize the patient's cardiovascular status.

Simultaneously, the neonatology team successfully delivered the newborn, who required immediate resuscitation due to signs of respiratory distress and poor Apgar scores at 1 and 5 minutes. The neonate was promptly transferred to the warmer, where positive pressure ventilation and supplemental oxygen were administered, gradually improving the infant's oxygenation and heart rate. Meanwhile, the results of the coagulation panel revealed prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), alongside low fibrinogen levels, confirming the suspicion of coagulopathy.

In response, the healthcare team initiated a massive transfusion protocol, administering fresh frozen plasma and cryoprecipitate to address the coagulation deficits. The nursing staff played a crucial role in monitoring the patient's vital signs, ensuring that transfusions were administered promptly, and communicating any changes in status to the multidisciplinary team. As the critical interventions took effect, the patient's blood pressure began to stabilize, and the surgical team could focus on completing the procedure and securing hemostasis. This phase of the patient's journey highlighted the importance of rapid clinical reasoning and teamwork in managing complex obstetric emergencies, setting the stage for continued vigilance in the immediate postoperative period.

Section 5

As the immediate postoperative period commenced, the nursing team conducted a comprehensive initial assessment to evaluate both the mother and the newborn's condition. The mother, though hemodynamically more stable, exhibited signs of continued physiological stress. Her blood pressure had increased to 100/65 mmHg, and her heart rate decreased to 120 bpm, indicating partial stabilization but still reflecting a compensatory tachycardia. Her respiratory rate remained elevated at 24 breaths per minute, and she reported mild dyspnea. The nursing team noted pallor and cool extremities, suggestive of ongoing peripheral vasoconstriction. The patient's laboratory results from the blood drawn post-surgery demonstrated an improvement in fibrinogen levels but revealed a significant drop in hemoglobin to 7.2 g/dL, necessitating further blood product support.

Meanwhile, the neonate, having been transferred to the Neonatal Intensive Care Unit (NICU), showed gradual improvement. Repeat Apgar scores at 10 minutes were 7, indicating better respiratory effort and heart rate response. Despite this progress, the infant remained on positive pressure ventilation, with blood gas analysis revealing a mild respiratory acidosis (pH 7.28, pCO2 52 mmHg). The neonatology team prioritized continuous respiratory support and temperature regulation while closely monitoring the infant’s oxygen saturation and arterial blood gases to guide further interventions.

As the nursing team continued to monitor both patients, the potential for new complications remained a concern. The mother appeared at risk for further hemorrhagic episodes or infection due to prolonged surgery and significant blood loss. The team was vigilant for signs of sepsis or systemic inflammatory response, such as fever or altered mental status, while ensuring timely administration of prophylactic antibiotics and additional blood products as needed. For the infant, the focus was on preventing complications associated with respiratory distress syndrome and ensuring adequate nutrition and glucose stability. The healthcare team's cohesive response and proactive management strategies were critical in addressing these challenges and optimizing outcomes for both mother and child.