2300: Client is a primigravida at 33 weeks gestation, who awoke to moderate bright red vaginal bleeding. She reports noticing light spotting earlier in the day, which she dismissed as benign. She denies abdominal pain, cramping, or contractions. Her pregnancy has been uncomplicated until recently. She reports increased fetal movement over the last 48 hours. One week ago, she presented to the ED with fever, fatigue, and body aches, and was diagnosed with influenza A. She was treated supportively and discharged home with hydration instructions. Over the past 24 hours, she has experienced nasal congestion and fatigue.
Four days ago, a transabdominal ultrasound showed:
- Fetus in cephalic position
- Normal amniotic fluid volume
Exam findings
- Abdomen: Soft, non-tender
- No uterine contractions noted on palpation
- Moderate amount of dried bright red blood was seen on the undergarments
- 1+ pedal edema
- Peripheral pulses 2+
2342: Fetal Heart Rate (FHR): 144 bpm, moderate variability, no decelerations
Temperature: 99.5°F (37.5°C)
HR 88 bpm
BP 137/78 mmHg
RR 18/min
Pulse oximetry 98% on room air
➢ Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client’s progress.
Actions to Take: Request a prescription for indomethacin | Prepare the client for a transvaginal ultrasound | Place the client in the lithotomy position for a manual cervical exam | Establish a peripheral vascular access device | Place the client in a room with monitored negative airflow
Potential Conditions: Placental abruption | Preeclampsia | Placenta previa | Influenza recurrence
Parameters to Monitor: Fetal heart rate pattern | Pedal edema | Amount and color of vaginal bleeding | Temperature | Nasal congestion and fatigue level
Actions to Take: Request a prescription for indomethacin | Prepare the client for a transvaginal ultrasound | Place the client in the lithotomy position for a manual cervical exam | Establish a peripheral vascular access device | Place the client in a room with monitored negative airflow
Parameters to Monitor: Fetal heart rate pattern | Pedal edema | Amount and color of vaginal bleeding | Temperature | Nasal congestion and fatigue level
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