A nurse is caring for a client with placenta previa. what interventions should be completed

Maternal Newborn Assessment

1.A nurse is performing a vaginal exam on a client who is in active labor. The nurse notes

the umbilical cord protruding through the cervix. Which of the following actions should

the nurse take?

Administer oxytocin to the client via intravenous infusion.

Apply oxygen at 2 L/min via nasal cannula.

Prepare for insertion of an intrauterine pressure catheter.

Assist the client into the knee-chest position.

2.A nurse is assessing a newborn who is 48 hr old and is experiencing opioid withdrawals.

Which of the following findings should the nurse expect?

Hypotonicity

Moderate tremors of the extremities

Axillary temperature 36.1° C (96.9° F)

Excessive sleeping

3.A nurse is reviewing a client's medical record and notes that the client is taking

tamoxifen. The nurse should identify that tamoxifen is used to treat which of the

following conditions?

Non-Hodgkin's lymphoma

Endometriosis

Breast cancer

Polycystic ovary syndrome

4.A nurse is caring for a client who is receiving oxytocin to augment labor. The client has

an intrauterine pressure catheter and an internal fetal scalp electrode for monitoring.

Which of the following is an indication that the nurse should discontinue the infusion?

Contraction frequency every 3 min

Contraction duration of 100 seconds

Fetal heart rate with moderate variability

Diagnosis

Placenta previa is diagnosed through ultrasound, either during a routine prenatal appointment or after an episode of vaginal bleeding. Most cases of placenta previa are diagnosed during a second-trimester ultrasound exam.

The initial diagnosis may be done with an ultrasound device on your abdomen. For more accurate images, you may also need a transvaginal ultrasound, which uses a wandlike device placed inside your vagina. Your provider will take care with the position of the device so as not to disrupt the placenta or cause bleeding.

Treatment

If placenta previa is diagnosed during a routine exam, you'll likely have more-frequent ultrasound exams to monitor any changes in the placenta.

In many women diagnosed with placenta previa early in their pregnancies, the condition resolves on its own. As the uterus grows, the distance between the cervix and the placenta may increase. Also, the direction of growth of the placenta may be higher in the uterus, and the edges of placental tissue near the cervix may shrink.

If placenta previa resolves, you may be able to plan for a vaginal delivery. If it doesn't resolve, you'll plan for a C-section delivery.

Treatment of bleeding

Vaginal bleeding after 20 weeks is treated as a medical emergency. You may be admitted to the hospital's labor and delivery unit. You and your baby will be monitored, and you may need a blood transfusion to replace lost blood.

If you are at 36 weeks, you'll likely have a C-section to deliver the baby. If you have extreme blood loss or there's a risk to the health of you or the baby, an emergency C-section may be needed before 36 weeks.

If this was the first time you've had bleeding and the bleeding has stopped for at least 48 hours, you may be sent home from the hospital. If you continue to have episodes of heavier bleeding, your health care team may recommend that you remain in the hospital.

Treatment with no bleeding

When there's no bleeding, the treatment goal is to lower the risk of possible bleeding and to get you as close to your delivery date as possible. Your care provider will likely recommend you avoid the following:

• Sexual intercourse or sexual activity that could lead to orgasm
• Moderate or strenuous exercise
• Moderate or heavy lifting
• Standing for long periods of time

If you are sent home from the hospital after a first bleeding episode, you'll be expected to follow these same recommendations to lower the risk of a second episode.

You'll be advised to get emergency medical care if you have vaginal bleeding or contractions. Your health care provider may ask whether you have support at home that allows for transportation to a nearby hospital.

Planned C-section delivery

Even if you've had no bleeding during your pregnancy due to placenta previa — or no bleeding since the first episode — you'll likely have a C-section delivery scheduled sometime between 36 and 37 weeks.

If your delivery is planned before 37 weeks, your health care provider will offer you corticosteroids to help your baby's lungs develop.

Coping and support

If you're diagnosed with placenta previa, you may worry about how your condition will affect you, your baby and your family. Some of these strategies might help you cope:

• Learn as much as you can about the condition.
• Find a support group through your clinic, hospital or other community organizations.
• Identify people who can help with daily activities at home or provide emotional support.
• Be specific about ways people can help if they offer you assistance.
• Make a transportation or child-care plan in case you need emergency services.

Preparing for your appointment

Placenta previa is usually diagnosed during a routine ultrasound exam or after an episode of vaginal bleeding. So you might not have time to prepare for an appointment about placenta previa as you might for typical prenatal care appointments.

If you don't need immediate medical care or are being sent home after treatment for vaginal bleeding, it's important to understand the plan for ongoing care and management.

Questions you may want to ask your provider after a diagnosis or at follow-up exams include:

• What signs or symptoms should prompt me to call you?
• What signs or symptoms should cause me to go to the hospital?
• When will I need my next ultrasound exam?
• What other follow-up care will I need?
• What activities do I need to stop or limit?
• What type of exercise do you recommend?
• Is there a possibility the placenta previa will resolve on its own?
• At what time will we likely know whether I can have a vaginal delivery?
• If we need to plan for a C-section delivery, when do you recommend scheduling it?
• Do you have additional information about placenta previa?
• Do you have information about support groups or services for women with placenta previa?

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, regarding your ability to manage care at home, particularly if you've already had one bleeding episode. These include:

• How far do you live from the hospital?
• How long would it take to get to the hospital in an emergency, including time to arrange child care and transportation?
• Do you have someone who could care for you or help with daily activities, so that you can restrict your activities or rest?

What are the nursing interventions for placenta previa?

What intervention should be completed for a client with placenta previa?

What is the management of placenta previa?

What should you not do with placenta previa?