A woman with a history of previous abruptio placentae with fetal ...

[rosent76]

A woman with a history of previous abruptio placentae with fetal demise is being seen in the perinatal clinic. She is now pregnant again in her early second trimester.
 
  She tells the nurse she is a Jehovah's Witness and she wants her chart to reflect her refusal to accept blood products if she hemorrhages again. Which action by the nurse is best?
  A.
  Ask the woman to consider an exception in order to save her baby's life if needed.
  B.
  Document the information on the chart and inform the health-care provider.
  C.
  Encourage the woman and provider to discuss appropriate delivery sites.
  D.
  Tell the woman a court can order the transfusion to save the baby.

Question 2

A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV line, which action should the nurse do next?
 
  A.
  Administer betamethasone (Celestone) just prior to delivery.
  B.
  Discuss pros and cons of continuous fetal monitoring.
  C.
  Facilitate laboratory work, including blood type and screen.
  D.
  Obtain informed consent for emergent delivery.

[Jordin Calloway]

Answer to Question 1

ANS: C
Jehovah's Witnesses do not accept blood products or their derivatives as part of their medical care. Because this woman is at high risk for a complicated pregnancy (another abruptio placentae) and hemorrhage, she should be advised to deliver in a tertiary care center that is prepared to manage catastrophic hemorrhage. The nurse should facilitate this discussion as part of providing holistic care. Asking the woman to reconsider (and go against her religious beliefs) is disrespectful. The nurse should document the information and inform the care provider, but this action in itself is incomplete. Telling the woman that a court can order her to have transfusions, although a true statement, is likely to be perceived as threatening and disrespectful, and certainly does not allow the nurse to provide care in a holistic manner.

Answer to Question 2

ANS: C
Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae. Bleeding accompanied by abdominal pain is the classic sign of placental abruption. Care includes obtaining maternal vital signs, assessing fetal heart rate, and starting an IV for fluid resuscitation or transfusion if needed. Blood work should be obtained for CBC, type and screen, coagulation studies, and a Kleihauer Betke determination, Betamethasone is given if delivery is not imminent. Continuous electronic fetal monitoring is the standard of care, and although the nurse should educate the patient on its use, this discussion does not take priority over obtaining diagnostic laboratory studies. An emergent delivery is a possible (not certain) outcome, but obtaining consent does not take priority over the diagnostic blood work.

[rosent76]

Excellent

[sailorcrescent]

Gracias!