Report: Hi, this is Dr. King calling. I am sending in Lelna…
Report: Hi, this is Dr. King calling. I am sending in Lelna Mengistu, a 37-year-old G4P2A1L2 at 32+1 weeksgestation. She is experiencing vaginal bleeding and says she doesn’t think she is having anycontractions. She is O+, hep-, and rubella immune. You will find all relevant prenatal labs andinformation in her EHR, and I will put in some preliminary prescriptions now. I’m downstairs in the oncall room. Call me once she has arrived and is on the fetal monitor. EHR: NURSING ASSESSMENT & NOTES 12/12 0230 Nursing Note: Client arrived to triage by herself. She got up to go to the bathroom and saw that she bled through her underwear and pajama bottoms. She did not notice any blood in the toilet but there was bright red blood on the toilet paper when she wiped. She placed a pad on and immediately called Dr. King who instructed her to come in. She states she was told her placenta is lying low but it would “probably resolve” before delivery, and she is scheduled for an ultrasound later this week. Husband at home trying to find a babysitter so he can join her, as they have no family nearby. She denies feeling any contractions. Dr. King notified of client’s arrival. PROVIDER PRESCRIPTIONS & NOTES 12/12 0250 Prescriptions: Admit to labor and delivery for observation Continuous external fetal and contraction monitoring Vaginal exam Complete blood count Place IV saline lock Type and screen COAG Panel: PT, PTT, Fibrinogen Transvaginal ultrasound Complete bedrest Place indwelling urinary catheter Other 12/12 0230 Client Information:Obstetric History: G4T2P0A1L2; LMP 5/01 EDD 2/5 Transvaginal ultrasound at 18 weeks identified a low-lying placenta Scheduled for repeat ultrasound at 32 weeks Medical History: Myomectomy Spontaneous vaginal delivery x2 Elective abortion Before answering this question, review the client’s health information in the EHR. Identify symptoms or risk factors that are related to placenta previa, placental abruption, or both. Select the correct answer. Question Placenta previa Placental abruption Both Uterine contractions History of abortion History of smoking Vaginal bleeding Advanced maternal age Abnormal placental location Increase in fundal height disproportionate to gestational weeks Recent blunt external abdominal trauma Abdominal tenderness/pain