Passage / Scenario

A nurse is caring for a 32-year-old female client who is at 28 weeks of gestation,
Nurses Notes
ÔÇó The client is a gravida 4, para 3. The client was admitted to the labor and delivery unit with a history of vaginal bleeding for 2 hours. The client states, ÔÇ£I started bleeding a couple of hours ago, but now I am saturating pads with bright red blood. I am so scared something is going to happen to my baby.ÔÇØ The abdomen is soft and nontender to palpation. The client reports no abdominal pain. The perineal pad is saturated with bright red vaginal bleeding, and blood is trickling down the clientÔÇÖs legs. Fundal height is at 27 cm. An electronic fetal monitor placed on the client shows FHR with minimal variability and no decelerations. No uterine contractions or uterine irritability noted. Blood was drawn for type and cross-match.
ÔÇó 0600: Client admitted with a history of vaginal bleeding for 2 hours. Client reports saturating pads with bright red blood. Abdomen soft and nontender. No abdominal pain reported. Perineal pad saturated with bright red blood, blood trickling down legs. Fundal height at 27 cm. FHR with minimal variability, no decelerations. No uterine contractions or irritability noted. Blood drawn for type and cross-match.

Diagnostic Results
ÔÇó Blood type and cross-match pending.
ÔÇó Complete blood count (CBC): Hemoglobin 10.5 g/dL, Hematocrit 32%, Platelets 150,000/mm┬│.

Medical History
ÔÇó Gravida 4, para 3.
ÔÇó Previous pregnancies: 1 full-term vaginal delivery, 1 preterm delivery at 34 weeks, 1 miscarriage at 10 weeks.
ÔÇó No known allergies.
ÔÇó No history of hypertension or diabetes.

Vital Signs
ÔÇó Temperature: 37┬░C (98.6┬░F)
ÔÇó Heart rate: 88/min
ÔÇó Respiratory rate: 18/min
ÔÇó Blood pressure: 120/80 mmHg
ÔÇó Oxygen saturation: 98% on room air

Physical Examination Results
ÔÇó Abdomen: Soft, nontender, fundal height at 27 cm.
ÔÇó Perineal area: Saturated pad with bright red blood, blood trickling down legs.
ÔÇó Fetal heart rate: Minimal variability, no decelerations.
ÔÇó No uterine contractions or irritability noted.

ProviderÔÇÖs Prescriptions
ÔÇó Bed rest with bathroom privileges.
ÔÇó Continuous electronic fetal monitoring.
ÔÇó Administer Rho(D) immune globulin if the client is Rh-negative.
ÔÇó IV access with normal saline at 125 mL/hr.
ÔÇó Prepare for possible ultrasound to assess placental location and fetal well-being.