What Should the Nurse Do?
Remy, a 32-year-old female, arrives at the obstetrics and gynecology clinic after experiencing vaginal bleeding and abdominal cramps at 10 weeks of gestation. She is visibly distressed and tearful. Remy reports having a smooth first trimester until yesterday when she noticed the bleeding. She denies any trauma or abdominal pain. Remy has a history of one previous full-term pregnancy without complications and no chronic medical conditions. Her vital signs include a blood pressure of 120/80 mm Hg, a heart rate of 80 beats per minute, and a respiratory rate of 18 breaths per minute. The health-care team is concerned about a potential early pregnancy loss.
1
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How might Remy's previous full-term pregnancy history contribute to the analysis of the current situation?
2
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As the nurse, what immediate actions should be taken to address Remy's bleeding and cramps?
Cindy, a 28-year-old female, arrives at the labor and delivery unit after experiencing decreased fetal movement at 38 weeks of gestation. She reports a sudden onset of abdominal pain and is visibly anxious. Cindy has a history of gestational diabetes, well controlled with diet, and a previous uncomplicated vaginal delivery. Fetal heart rate monitoring reveals absent fetal heart tones, and ultrasound confirms the devastating news of an intrapartum fetal death.
3
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Considering the absence of fetal heart tones, what would be the priority hypotheses regarding the cause of the intrapartum fetal death, and how would you approach communicating this information to Cindy?
4
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As the nurse, what immediate and long-term solutions can be implemented to support Cindy and her family in the aftermath of an intrapartum fetal death?