Reference no: EM133606160

Case Study: S. M. is a 36-year-old, Gravida 9 Para 6 who arrives to L &D with heavy vaginal bleeding and uterine contractions. She has received no prenatal care, according to her last menstrual period she is 34 weeks pregnant. S.M. admitted to cocaine use during pregnancy and is trying to leave a physically abusive relationship with the father of the baby. The nurse recognizes which factors that put S. M. at risk for complications in this pregnancy?

Questions: Upon assessment, S. M. describes pain 10/10 located over right side of uterus. Her uterus is "boardlike" and rigid. BP: 170/100, HR: 110, bright red bleeding on saturated peripad.

• What two late pregnancy bleeding disorders would the nurse suspect?
• What findings differentiate the two late pregnancy bleeding disorders?
• The nurse places a large bore IV and begins infusing fluids, per orders. What further assessments, laboratory work, and diagnostics would the nurse anticipate?
• Ultrasound rules out Placenta Previa. Placental Abruption is highly suspected with S. M.'s pain, contractions, and rigid abdomen. Fetal monitor displays FHR of 180, with minimal variability. S. M. is contracting every 2 minutes. She begins to have profuse bright red vaginal bleeding. Although, cesarean birth is not optimal due to bleeding, S. M. is remote from vaginal delivery. The healthcare team makes the decision for emergency cesarean birth. What nursing actions are anticipated? How can the nurse treat her in a holistic lens?
• If bleeding continues, what clotting disorder could S.M. be at risk for? And what assessment findings would present in this disorder?