A patient with suspected abruptio placenta presents with a firm, tender uterus, late decelerations on fetal monitoring, and signs of hypovolemic shock. Lab results indicate anemia, thrombocytopenia, and coagulopathy. Which immediate nursing intervention is most critical in managing this patient’s condition?

C) Prepare for a blood transfusion and monitor vital signs closely.

A) Administer oxygen via non-rebreather mask at 10-15 L/min.

B) Place the patient in a supine position to improve circulation.

C) Prepare for a blood transfusion and monitor vital signs closely.

D) Encourage oral fluid intake to address dehydration.

A pregnant patient presents with a firm, tender uterus and late decelerations on fetal monitoring. Lab results indicate anemia, thrombocytopenia, and coagulopathy. The obstetric team plans for an emergency C-section due to suspected abruptio placenta. Which nursing intervention is a priority to stabilize the patient before surgery?

A) Administer intravenous fluids and blood products as ordered.

B) Position the patient in a supine position to improve comfort.

C) Prepare the patient for epidural anesthesia to manage pain.

D) Encourage the patient to ambulate to prevent deep vein thrombosis.

Following an emergency C-section with significant blood loss and hemodynamic instability, which nursing intervention is most critical to prioritize for this patient in the immediate postoperative period?

B) Monitor urine output and renal function closely.

A) Initiate early mobility to prevent venous thromboembolism.

B) Monitor urine output and renal function closely.

C) Encourage oral fluid intake to promote hydration.

D) Apply warm blankets to maintain normothermia.

A patient who underwent an emergency C-section due to abruptio placenta is now in the intensive care unit. Her blood pressure is 100/70 mmHg, heart rate is 140 bpm, and she has an estimated blood loss of 1500 mL. Which nursing intervention should be prioritized to address her current condition?

B) Start vasopressor therapy to stabilize blood pressure

A) Administer pain medication to manage postoperative discomfort

B) Start vasopressor therapy to stabilize blood pressure

C) Initiate continuous renal replacement therapy to prevent acute kidney injury

D) Administer supplemental oxygen to improve tissue perfusion

A patient in the ICU post-emergency C-section is showing signs of hemodynamic instability with low blood pressure, tachycardia, and altered mental status despite aggressive treatment. Her lab results indicate anemia, elevated serum lactate, and coagulopathy. Which nursing intervention is the priority to prevent further deterioration?

B) Initiate vasopressor support to maintain adequate mean arterial pressure.

A) Administer additional units of packed red blood cells to improve hemoglobin levels.

B) Initiate vasopressor support to maintain adequate mean arterial pressure.

C) Increase supplemental oxygen to improve tissue oxygenation.

D) Implement renal protective strategies to prevent acute kidney injury.

A patient in the ICU following an emergency C-section is exhibiting signs of shock with low blood pressure, tachycardia, and altered mental status. Laboratory results show a hemoglobin level of 7.2 g/dL, elevated serum lactate, rising creatinine, and coagulopathy. Which of the following interventions should the nurse prioritize to address the patient's condition?

B) Initiate vasopressor therapy to improve hemodynamic stability and peripheral perfusion.

A) Administer an additional unit of packed red blood cells to correct the anemia.

B) Initiate vasopressor therapy to improve hemodynamic stability and peripheral perfusion.

C) Increase the infusion rate of intravenous fluids to enhance renal perfusion.

D) Schedule an immediate CT scan to identify potential internal bleeding sources.

A patient with abruptio placenta is exhibiting signs of worsening hemodynamic instability, including confusion, delayed capillary refill, and cooler extremities. Arterial blood gas analysis shows metabolic acidosis. Which intervention should the nurse prioritize to address the patient's condition?

A) Increase the rate of intravenous fluids to improve perfusion

B) Prepare the patient for immediate surgical intervention

C) Initiate renal replacement therapy to manage acute kidney injury

D) Administer additional vasopressors to stabilize blood pressure

A patient with abruptio placenta is showing signs of hemodynamic instability despite aggressive management with vasopressors and transfusion therapy. The arterial blood gas analysis reveals metabolic acidosis, and serum lactate levels are elevated. What is the most appropriate next step in managing this patient to prevent further deterioration?

B) Initiate renal replacement therapy

A) Increase the dosage of vasopressors

B) Initiate renal replacement therapy

C) Administer sodium bicarbonate to correct acidosis

D) Perform surgical re-exploration to identify hemorrhage

A patient is experiencing respiratory compromise with an increased respiratory rate and low oxygen saturation despite high-flow oxygen. After intubation and mechanical ventilation, what is the nursing priority in managing this patient's condition post-intubation?

B) Monitor and adjust ventilator settings to optimize oxygenation.

A) Administer sedation to ensure the patient remains calm.

B) Monitor and adjust ventilator settings to optimize oxygenation.

C) Prepare for immediate extubation to assess spontaneous breathing.

D) Conduct frequent neurological checks to assess for signs of hypoxia.

A patient in the ICU is experiencing respiratory compromise with an increased respiratory rate, decreased oxygen saturation, and diminished breath sounds at the bases. The patient's condition is further complicated by ongoing intra-abdominal bleeding and hemodynamic instability. Which of the following nursing interventions is the most critical to prioritize in this scenario?

B) Preparing the patient for immediate intubation and mechanical ventilation.

A) Administering diuretics to manage potential pulmonary edema.

B) Preparing the patient for immediate intubation and mechanical ventilation.

C) Increasing the rate of IV fluid administration to counteract hypotension.

D) Initiating aggressive pain management to reduce metabolic demand.

abruptio placenta - Nursing Case Study

Pathophysiology

• Primary mechanism: Abruptio placenta primarily involves the premature separation of the placenta from the uterine wall, often triggered by vascular injury or trauma. This separation disrupts blood flow between the mother and fetus, leading to potential hypoxia and nutrient deprivation for the fetus.

• Secondary mechanism: The separation often causes bleeding into the decidua basalis, the uterine lining, which can form a hematoma. The expanding hematoma exacerbates placental detachment and contributes to further vascular compromise, worsening fetal and maternal outcomes.

• Key complication: This condition can lead to significant maternal hemorrhage and disseminated intravascular coagulation (DIC), causing severe coagulopathy and endangering both maternal and fetal health. Prompt recognition and intervention are crucial to manage blood loss and stabilize both mother and child.

Patient Profile

Demographics:

32-year-old female, accountant

History:

• Key past medical history: Gestational hypertension, two previous cesarean sections

• Current medications: Labetalol, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Sudden onset of abdominal pain and vaginal bleeding

• Key symptoms: Severe lower abdominal pain, uterine tenderness, decreased fetal movements, dizziness

• Vital signs: Blood pressure 140/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 37.2°C, oxygen saturation 94% on room air

Section 1

As the healthcare team begins the initial assessment, the patient is placed in a left lateral position to optimize uteroplacental blood flow. A focused physical examination reveals a firm, tender uterus with no signs of relaxation between contractions, indicating a potential concealed hemorrhage. The fetal heart rate is monitored and shows late decelerations, suggesting fetal distress. The patient's vital signs are re-assessed, showing a concerning trend: blood pressure has dropped to 130/85 mmHg, and her heart rate has increased to 120 bpm. The patient's pallor and continued dizziness are indicative of potential hypovolemic shock due to ongoing blood loss.

Lab results return, showing a hemoglobin level of 9 g/dL, indicative of anemia, and a platelet count of 90,000/mm³, raising concerns for thrombocytopenia. Coagulation studies reveal an elevated prothrombin time (PT) and partial thromboplastin time (PTT), suggesting the onset of coagulopathy. Fibrinogen levels are markedly decreased, a common finding in acute disseminated intravascular coagulation (DIC). The clinical team recognizes the urgent need for transfusion of blood products to manage the coagulopathy and stabilize the patient.

Given these developments, the obstetric team decides to proceed with an emergency C-section to deliver the baby and manage the abruptio placenta. The team prepares for potential massive transfusion and neonatal resuscitation, aware of the high-risk nature of the situation. An anesthesiologist is consulted to discuss the safest approach given the patient's cardiovascular instability and risk of further bleeding. This decision reflects quick clinical reasoning to prevent maternal and fetal morbidity and mortality, setting the stage for the next phase of acute intervention.

Section 2

As the emergency C-section begins, the surgical team remains vigilant for any signs of further complications. Despite the urgency, the anesthesiologist opts for general anesthesia due to the patient's cardiovascular instability and potential coagulopathy, aiming to ensure rapid control of the airway and maintain hemodynamic stability. As the surgery progresses, the obstetrician encounters significant retroplacental clotting, confirming the severity of the abruptio placenta. The baby is delivered quickly, albeit with Apgar scores of 4 at one minute and 6 at five minutes, indicating mild to moderate distress but showing signs of improvement with immediate neonatal resuscitation efforts, including positive pressure ventilation and supplemental oxygen.

Meanwhile, the patient's hemodynamic status is closely monitored. Intraoperative findings reveal an estimated blood loss of 1500 mL, exacerbating the patient's hypovolemic state. The anesthesiologist and surgical team coordinate the administration of a massive transfusion protocol, including packed red blood cells, fresh frozen plasma, and cryoprecipitate, to address the patient's anemia and coagulopathy. The patient's vital signs are unstable, with blood pressure dropping further to 100/70 mmHg despite volume resuscitation, and a heart rate peaking at 140 bpm, underscoring the ongoing challenge of managing her condition.

Postoperatively, the patient is transferred to the intensive care unit for continued monitoring and support. She remains at risk for further complications, such as acute kidney injury due to hypoperfusion, and the development of multi-organ dysfunction syndrome. The clinical team prioritizes close surveillance of her renal function, coagulation status, and hemodynamic stability, while also ensuring adequate pain control and preventing infection. The successful delivery and stabilization of both mother and child mark a critical juncture in their care, but the team remains alert for any signs of deterioration, ready to adjust the treatment plan as needed. This scenario highlights the importance of ongoing clinical assessment and timely interventions in managing complex obstetric emergencies.

Section 3

In the hours following the emergency C-section, the patient's condition remains a concern as she is closely monitored in the intensive care unit. Initial assessment findings indicate that despite aggressive fluid resuscitation and transfusions, her blood pressure persists at a precariously low level of 90/60 mmHg, with a heart rate consistently around 130 bpm. Her oxygen saturation is stable at 95% on supplemental oxygen, but there are signs of peripheral perfusion issues, including cool extremities and delayed capillary refill. The nursing team performs frequent neurological checks, noting her slightly altered mental status, with occasional confusion and difficulty focusing, likely due to her unstable hemodynamics and blood loss.

New diagnostic results from the laboratory reveal concerning trends. Her hemoglobin level has dropped to 7.2 g/dL, indicating ongoing anemia despite transfusion efforts. Additionally, her serum lactate level is elevated at 4 mmol/L, suggesting tissue hypoxia and potential progression towards shock. The patient's renal function tests show a creeping rise in creatinine levels, now at 1.8 mg/dL from a baseline of 0.9 mg/dL, which signals a risk of acute kidney injury. Furthermore, coagulation studies reflect a persistent coagulopathy, with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), necessitating continuous monitoring and possible adjustments in transfusion strategies.

In response to these findings, the clinical team intensifies their efforts to stabilize the patient. They adjust the massive transfusion protocol, increasing the ratio of plasma and platelets to address the coagulopathy more effectively. Renal protective strategies, such as optimizing her hemodynamics with vasopressors and ensuring adequate hydration, are initiated to prevent further kidney damage. The team also considers further diagnostic imaging to assess for any hidden sources of bleeding or hematoma formation. These interventions are crucial as the team strives to prevent the progression to multi-organ dysfunction syndrome, emphasizing the importance of dynamic clinical reasoning and timely adjustments in the management plan to safeguard the patient's recovery trajectory.

Section 4

As the clinical team implements the adjusted management strategies, a change in the patient's status prompts immediate attention. Over the next few hours, despite the administration of vasopressors and targeted transfusion therapy, the patient's blood pressure remains marginally low, fluctuating around 92/58 mmHg. Her heart rate, although slightly improved, remains tachycardic at 125 bpm. She begins to exhibit more pronounced signs of hemodynamic instability, including increased confusion and an inability to maintain coherent conversation, signaling worsening cerebral perfusion. The nursing team notices a further delay in capillary refill, now exceeding four seconds, and her extremities become noticeably cooler.

In response to the deteriorating status, an urgent arterial blood gas analysis is conducted, revealing a pH of 7.28, indicating metabolic acidosis likely due to ongoing tissue hypoxia and inadequate perfusion. The serum lactate level has risen further to 5.5 mmol/L, a clear marker of worsening shock. Concurrently, the repeat renal function tests show a concerning increase in creatinine to 2.2 mg/dL, highlighting the progression towards acute kidney injury. The coagulation studies continue to show prolonged PT and aPTT, despite the intensified transfusion protocol, suggesting the need for ongoing reassessment and adjustment in the management plan.

These developments necessitate a reevaluation of the current therapeutic approach. The clinical team, prioritizing the prevention of multi-organ dysfunction, considers the initiation of renal replacement therapy to support kidney function and avert further complications. Additionally, they deliberate the potential need for a surgical re-exploration to identify and address any ongoing sources of hemorrhage. The situation calls for a multidisciplinary discussion to balance aggressive intervention with the patient's overall stability and recovery potential, ensuring that each decision is informed by a synthesis of the evolving clinical picture and judicious clinical reasoning. This critical juncture underscores the dynamic nature of patient care in complex cases of abruptio placenta, where timely and informed decisions are pivotal to altering the course towards recovery.

Section 5

As the clinical team convenes to discuss the possibility of surgical re-exploration, the patient's condition undergoes another shift. Her respiratory rate increases to 28 breaths per minute, and oxygen saturation drops to 88% on high-flow oxygen, suggesting the onset of respiratory compromise. Auscultation of the lungs reveals diminished breath sounds at the bases, raising concerns about potential pulmonary edema or evolving acute respiratory distress syndrome (ARDS) secondary to the systemic inflammatory response. The decision is made to intubate and mechanically ventilate the patient to stabilize her respiratory status and optimize oxygen delivery.

In parallel, the team receives new diagnostic results from the recent imaging studies, including a repeat bedside ultrasound. The ultrasound reveals an increased volume of free fluid in the abdomen, consistent with ongoing intra-abdominal bleeding. Despite the transfusion efforts, the hemoglobin level has dropped further to 7.2 g/dL, reinforcing the suspicion of continued hemorrhage. This new evidence, combined with the patient's hemodynamic instability and the laboratory indicators of coagulopathy, strengthens the case for urgent surgical intervention to control the bleeding source.

Given these developments, the attending physician consults with the surgical team to prepare for an exploratory laparotomy. The decision to proceed is made with caution, weighing the risks of surgery against the likelihood of further deterioration without intervention. The nursing team coordinates closely with the anesthesiology and surgical teams to ensure a seamless transition to the operating room, emphasizing the importance of maintaining hemodynamic support and monitoring throughout the perioperative period. This critical step, guided by a thorough assessment and clinical reasoning, aims to address the root cause of the patient's decline and offers a pathway towards stabilization and recovery.