The nurse is caring for a woman with a placental abruption and ...

[mrsjacobs44]

The nurse is caring for a woman with a placental abruption and suspects the patient has developed disseminated intravascular coagulation (DIC). What interventions does the nurse anticipate?
 
  A.
  Administering IV fibrinogen
  B.
  Performing hourly vaginal exams to assess for cervical dilation
  C.
  Performing blood pressure assessments every 4 hours
  D.
  Obtaining consent for a cesarean birth

Question 2

The perinatal nurse is caring for a preeclamptic patient at 35 weeks' gestation. The patient's newest laboratory results include the following: platelet count 98,000/mm3 and RBC 3.1 million/ L. What action by the nurse is most appropriate?
 
  A.
  Administer betamethasone (Celestone).
  B.
  Increase the patient's IV fluids.
  C.
  Maintain the patient on bedrest.
  D.
  Notify the health-care provider immediately.

[mmpiza]

Answer to Question 1

ANS: A
DIC is a severe complication of placental abruption. Interventions include administration of IV cryoprecipitate or fibrinogen. To avoid further tissue damage, pelvic and vaginal exams are not performed. The woman is critically ill, and vital signs need to be monitored more often than every 4 hours. Vaginal birth is desirable unless fetal distress is present or there are other indications. If a cesarean birth is necessary, the nurse will need to place the signed informed consent form on the chart.

Answer to Question 2

ANS: D
This woman's laboratory values indicate the possible development of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), which is a factor that may necessitate immediate interventions to facilitate birth. Betamethasone is not given after 34 weeks' gestation. Increasing the IV fluids is not warranted. The patient should be maintained on bedrest, but notifying the provider is a priority.