The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for labor induction from a rural health care facility with an intrauterine fetal demise of unknown duration. Which intervention is most important when receiving care of the client?

Question

Quizplus · Accepted Answer

Pregnant clients, especially those with placental abruption and intrauterine fetal demise, are at risk for disseminated intravascular coagulation (DIC). Thromboplastin from the retained dead fetus activates the clotting cascade, followed by consumption of clotting factors and platelets that leads quickly to life-threatening external and internal bleeding. Signs of DIC include frank external bleeding (eg, venipuncture site bleeding), signs of internal bleeding (eg, petechiae, ecchymosis), and organ damage from blood clotting (eg, respiratory distress, renal failure). Baseline laboratory tests (eg, coagulation studies, platelets, fibrinogen) and physical assessment for signs of DIC are a priority for at-risk clients because clotting and bleeding are often sudden and life-threatening (Option C). (Option A) The nurse applies a tocodynamometer ("toco") to monitor for contractions that may begin prior to oxytocin administration, but this is not a priority over laboratory assessment for DIC. (Option B) The nurse offers chaplain services and emotional support to clients and families experiencing pregnancy loss, but this is not the priority action. (Option D) A hemodynamically stable client with fetal demise should have labor induced as quickly as possible to prevent DIC, but this does not take priority over initial laboratory assessment. Educational objective: Pregnant clients, especially those with placental abruption and intrauterine fetal demise, are at risk for developing disseminated intravascular coagulation (DIC). DIC can progress quickly; therefore, the nurse should prioritize assessment for any signs of DIC (eg, abnormal laboratory tests [coagulation studies, fibrinogen, platelets], signs of bleeding) before performing other interventions.

The Nurse Receives Report for a Client at 36 Weeks