A patient at 32 weeks of gestation is diagnosed with complete placenta previa and oligohydramnios following an ultrasound. The patient experiences intermittent painless vaginal bleeding and reduced fetal movements. Based on these findings, which nursing intervention should the nurse prioritize?

C) Initiate continuous electronic fetal monitoring to closely observe fetal status.

A) Encourage the patient to increase fluid intake to improve amniotic fluid levels.

B) Prepare the patient for immediate delivery to prevent further complications.

C) Initiate continuous electronic fetal monitoring to closely observe fetal status.

D) Educate the patient on the importance of pelvic rest to prevent further bleeding.

A patient at 32 weeks of gestation with a diagnosis of complete placenta previa and oligohydramnios presents with mild anemia and occasional fetal distress. Which of the following nursing interventions is the priority for this patient?

C) Monitor fetal heart rate and maternal vital signs closely.

A) Administer IV fluids to improve amniotic fluid levels.

B) Prepare the patient for a possible emergency cesarean section.

C) Monitor fetal heart rate and maternal vital signs closely.

D) Educate the patient about the signs of preterm labor.

A patient with placenta previa is experiencing lightheadedness, increased vaginal bleeding, and a drop in blood pressure. The fetal heart rate shows variable decelerations, and the biophysical profile score has decreased. What is the priority nursing intervention to address the patient's current condition?

C) Prepare the patient for an emergent cesarean section.

A) Administer oxygen via face mask.

B) Position the patient in a left lateral position.

C) Prepare the patient for an emergent cesarean section.

D) Initiate continuous fetal heart rate monitoring.

A patient with placenta previa is experiencing increased vaginal bleeding, hypotension, and fetal distress. What is the most appropriate initial nursing intervention to stabilize the patient before an emergent cesarean section?

B) Initiate an IV line with lactated Ringer's solution.

A) Administer oxygen via nasal cannula at 2 L/min.

B) Initiate an IV line with lactated Ringer's solution.

C) Position the patient in Trendelenburg position.

D) Apply continuous fetal heart rate monitoring.

A postpartum nurse is caring for a patient who has just undergone an emergency cesarean section due to fetal distress and maternal hypotension caused by suspected placental abruption. The patient's blood pressure is currently stable at 100/70 mmHg, and her heart rate is 95 beats per minute. Which nursing intervention is the priority to ensure the patient's continued stabilization and recovery?

D) Assess the patient's lochia for color and amount frequently

A) Monitor the patient's urine output every hour

B) Encourage early ambulation to prevent thromboembolism

C) Administer prescribed analgesics to manage postoperative pain

D) Assess the patient's lochia for color and amount frequently

A patient experiencing hypotension due to blood loss is being prepared for an emergency cesarean section. The medical team has already administered IV fluids, and the patient's blood pressure has stabilized slightly. What should be the nurse's next priority action in preparing the patient for surgery?

A) Administer oxygen via nasal cannula to improve maternal and fetal oxygenation.

B) Encourage the patient to ambulate to improve circulation.

C) Delay the cesarean section until the patient's heart rate normalizes.

D) Initiate continuous fetal heart monitoring throughout the preparation period.

During the postoperative period following a cesarean section complicated by placental abruption and previa, which nursing intervention is most critical to ensure the mother's hemodynamic stability?

B) Monitoring the patient's hemoglobin and hematocrit levels closely

A) Administering prescribed antibiotics to prevent infection

B) Monitoring the patient's hemoglobin and hematocrit levels closely

C) Encouraging early ambulation to prevent deep vein thrombosis

D) Providing emotional support to address anxiety about the newborn

A postpartum patient who underwent a cesarean delivery due to placenta previa and partial placental abruption is experiencing hypotension and tachycardia. Which nursing intervention is the highest priority in managing this patient's condition?

C) Administer additional IV fluids and monitor for blood transfusion needs

A) Administer prescribed antibiotics to prevent infection

B) Continue to monitor vital signs every 4 hours

C) Administer additional IV fluids and monitor for blood transfusion needs

D) Encourage early ambulation to prevent thromboembolism

A postpartum patient who has undergone a cesarean delivery is exhibiting signs of hypovolemia, coagulopathy, and mild respiratory distress. Which nursing intervention should be prioritized to address the patient's current condition and prevent further deterioration?

C) Prepare and administer fresh frozen plasma to address coagulopathy.

A) Increase the rate of intravenous fluid infusion to manage hypovolemia.

B) Administer diuretics to reduce the risk of fluid overload and respiratory distress.

C) Prepare and administer fresh frozen plasma to address coagulopathy.

D) Initiate high-flow oxygen therapy to improve oxygen saturation.

A postoperative cesarean section patient is experiencing ongoing hypotension, tachycardia, pale skin, prolonged capillary refill, and reduced urine output. Her hemoglobin and hematocrit levels are low, and she is receiving blood product transfusions. Given these clinical findings, which nursing intervention is most appropriate to prioritize at this time?

B) Monitor the patient's respiratory status closely for signs of fluid overload.

A) Increase the rate of IV fluid administration to improve blood volume.

B) Monitor the patient's respiratory status closely for signs of fluid overload.

C) Administer diuretics to address potential fluid overload and improve urine output.

D) Prepare for the immediate administration of vasopressors to stabilize blood pressure.

placenta previa - Nursing Case Study

Pathophysiology

• Primary mechanism: Placenta previa occurs when the placenta implants in the lower uterine segment, partially or completely covering the cervical os. This abnormal placement disrupts normal placental function and uterine contractility during labor.

• Secondary mechanism: As the lower uterine segment stretches and thins in late pregnancy or during labor, the placenta may shear or detach, leading to bleeding. This is due to the placenta's inability to stretch with the uterine wall, increasing the risk of hemorrhage.

• Key complication: The main complication is painless, bright red vaginal bleeding in the third trimester, which can lead to maternal and fetal morbidity. Immediate medical attention is crucial to manage bleeding and prevent severe outcomes, such as preterm birth or hemorrhagic shock.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Previous cesarean section, mild hypertension

• Current medications: Labetalol 100 mg twice daily, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Vaginal bleeding in the second trimester

• Key symptoms: Intermittent painless vaginal bleeding, mild uterine cramping, reduced fetal movements

• Vital signs: Blood pressure 140/90 mmHg, heart rate 100 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 97% on room air

Section 1

New Diagnostic Results:

In response to the patient's presentation of intermittent painless vaginal bleeding and reduced fetal movements, a detailed ultrasound and lab work were conducted to assess both maternal and fetal well-being. The ultrasound confirmed a complete placenta previa, where the placenta entirely covers the cervical os, explaining the persistent episodes of bleeding. Additionally, the ultrasound indicated a moderate reduction in amniotic fluid levels, a condition known as oligohydramnios, which can pose further risks to fetal development and contribute to decreased fetal movements.

The laboratory results revealed a mild decrease in hemoglobin and hematocrit levels, indicative of ongoing blood loss, although the patient's vital signs remain stable for the time being. A non-stress test was conducted to assess fetal wellbeing, showing occasional variable decelerations, suggesting some degree of fetal distress. These findings highlight the need for careful monitoring and potential interventions to manage the placenta previa and address any emerging complications.

Given the ultrasound and lab findings, the patient and her healthcare team need to consider the implications for both immediate and long-term management. Strategies may include close monitoring of maternal and fetal status, possibly admitting the patient for inpatient observation, and planning for a potential early delivery if maternal or fetal conditions deteriorate. The healthcare team must weigh the risks of preterm birth against the potential for severe maternal hemorrhage, using clinical reasoning to decide the optimal timing for intervention.

Section 2

As the patient remains under careful observation, her condition begins to show signs of change, prompting immediate reassessment. The patient reports feeling increasingly lightheaded and experiences a sudden increase in the frequency of vaginal bleeding. A repeat set of vital signs reveals that her blood pressure has dropped to 90/60 mmHg, and her heart rate has increased to 105 beats per minute, indicating a compensatory response to potential blood loss. The nursing team conducts a focused physical examination, noting that the patient appears pale and slightly diaphoretic. These findings suggest a progression in the severity of her condition, warranting further evaluation and intervention.

Given these developments, the healthcare team decides to perform another complete blood count (CBC) and type and crossmatch for potential blood transfusion. The repeat CBC shows a further decrease in hemoglobin to 9.5 g/dL from the previous 10.5 g/dL, corroborating ongoing blood loss. The fetal heart rate monitoring reveals persistent variable decelerations, and the biophysical profile score has decreased, indicating worsening fetal status. These clinical data points necessitate a multidisciplinary discussion to determine the most appropriate course of action, balancing the escalating risk of maternal hemorrhage with the complications associated with preterm delivery.

The team deliberates the benefits and risks of immediate delivery versus continued observation and conservative management. Given the patient's declining hemodynamic status and the evidence of fetal distress, the consensus leans towards preparing for an expedited delivery via cesarean section. This decision aligns with the priority of maintaining maternal stability and optimizing neonatal outcomes, underscoring the critical importance of timely intervention in managing placenta previa complicated by oligohydramnios and potential fetal compromise. The plan is to stabilize the patient with IV fluids and prepare the operating room for an emergent cesarean delivery, ensuring that the necessary blood products and neonatal resuscitation team are ready.

Section 3

As the medical team moves swiftly to stabilize the patient and prepare for the cesarean delivery, they administer IV fluids to address her hypotension and monitor her response closely. Within minutes, her blood pressure begins to stabilize slightly, rising to 95/65 mmHg, though her heart rate remains elevated at 100 beats per minute. Despite these initial improvements, the patient continues to exhibit signs of ongoing blood loss, as evidenced by her persistent pallor and diaphoresis. A repeat assessment of the fetal heart rate shows variable decelerations are now accompanied by late decelerations, indicating increasing fetal compromise and underscoring the urgent need for delivery.

In parallel, the type and crossmatch results return, confirming the availability of compatible blood products. The team stands ready to administer a transfusion should the patient's hemodynamic status further deteriorate. The anesthesiologist evaluates the patient for anesthesia, deciding on a spinal anesthetic to minimize the risks associated with general anesthesia in her current condition. As preparations for the cesarean section are finalized, the obstetrician reassures the patient and her family, explaining the plan and expected outcomes, while the neonatal team stands by to provide immediate care to the newborn.

As the patient is transferred to the operating room, her condition remains fragile, yet the proactive measures taken thus far have mitigated further deterioration. The multidisciplinary team's cohesive planning and swift response highlight the critical role of interprofessional collaboration in managing complex obstetric emergencies. The focus now shifts to executing the cesarean delivery efficiently and safely, with all personnel acutely aware of their roles in ensuring both maternal and neonatal well-being.

Section 4

As the cesarean delivery commences, the surgical team remains vigilant, aware of the potential for new complications given the patient's condition. During the initial incision, the obstetrician notes a significant amount of additional bleeding, indicating the likelihood of a partial placental abruption in conjunction with the placenta previa. The patient's blood pressure, which had stabilized somewhat, begins to drop again, now reading 85/55 mmHg, with her heart rate climbing to 110 beats per minute. The anesthesiologist promptly administers additional IV fluids and prepares to initiate a blood transfusion. As the obstetric team works quickly, a unit of packed red blood cells is transfused, contributing to a gradual improvement in the patient’s vital signs.

In the midst of these developments, the neonatal team prepares for potential complications with the newborn, given the fetal heart rate decelerations observed earlier. As the baby is delivered, the team quickly assesses the infant's condition. The newborn presents with a weak cry and poor muscle tone, prompting immediate intervention. The neonatal team administers positive pressure ventilation and oxygen, which helps to stabilize the infant’s oxygen saturation levels and heart rate. Within minutes, the newborn's Apgar score improves from an initial 4 to a 7 at five minutes, indicating a favorable response to the resuscitative efforts.

With both mother and baby showing signs of stabilization, the team shifts focus to continued monitoring and supportive care. The obstetrician carefully evaluates the uterine cavity for any retained placental tissue and ensures adequate hemostasis. Meanwhile, the nursing staff continues to monitor the mother's vital signs and administer additional blood products as needed to maintain her hemodynamic stability. As the immediate crisis subsides, the team recognizes the importance of ongoing vigilance and coordinated care in the postoperative period, anticipating potential challenges such as anemia and infection, and preparing to address them proactively.

Section 5

As the surgical team completes the cesarean delivery, the focus shifts to the immediate postoperative care of the mother, who remains at risk for further complications. The nursing team initiates a comprehensive assessment to detect any signs of deteriorating condition. The patient's vital signs are closely monitored, revealing that although her blood pressure has slightly improved to 90/60 mmHg, her heart rate remains elevated at 105 beats per minute. She appears pale, and her capillary refill time is prolonged, indicating ongoing concerns about her circulatory status. The nursing staff notes that her urine output is reduced, measuring only 20 mL over the past hour, raising concerns about potential acute kidney injury secondary to hypovolemia.

Laboratory results return and provide further insight into the patient’s condition. Her hemoglobin level has dropped to 8.0 g/dL, and her hematocrit is at 24%, confirming significant blood loss. Additionally, her coagulation profile shows a slight elevation in prothrombin time (PT), suggesting the development of a coagulopathy, possibly due to consumption of clotting factors during the excessive bleeding episode. The healthcare team initiates a plan to administer fresh frozen plasma in conjunction with ongoing blood product transfusions to address the coagulopathy and support hemostatic function.

Despite the interventions, the patient begins to exhibit mild respiratory distress, with an increased respiratory rate of 24 breaths per minute and an oxygen saturation of 92% on room air. The nurse promptly applies supplemental oxygen via nasal cannula, which helps to improve her saturation to 96%. The team considers the potential for fluid overload or transfusion-related acute lung injury (TRALI) as possible contributors to her respiratory changes. As they continue to monitor the patient, the healthcare team remains vigilant for signs of further complications, such as infection or delayed postpartum hemorrhage, and prepares to implement additional therapeutic strategies as needed to ensure both her and her newborn's continued recovery and well-being.