A nurse is caring for a client at 34 weeks gestation.

Medical History: The client has a history of gestational diabetes and mild hypertension.

Diagnostic Results: The latest ultrasound shows normal fetal growth and development. Blood sugar levels have been slightly elevated in the past week.

Vital Signs: Blood pressure has been steadily increasing over the past few hours. Heart rate and temperature remain within normal limits.

Complete the diagram by selecting the condition the client is most likely experiencing? Two actions the nurse should take to address that condition and two parameters the nurse should monitor to assess the client’s progress

Choice A:
Purpose of the Biophysical Profile (BPP): The BPP is a non-invasive test that combines ultrasound and fetal heart rate monitoring to assess fetal well-being, specifically in the third trimester of pregnancy. It evaluates five parameters: fetal breathing movements, fetal body movements, fetal tone, amniotic fluid volume, and fetal heart rate reactivity. Each parameter is assigned a score of 0 or 2, resulting in a total score of 0 to 10. A score of 8 or 10 is generally considered reassuring of fetal well-being, while a score of 6 or below may warrant further evaluation or intervention.
Timing of BPP: It's typically performed in the third trimester, often after 32 weeks of gestation, when the fetus has developed regular sleep-wake cycles and breathing movements.
Risk Assessment: It's often recommended for pregnancies considered high-risk, such as those with: Maternal diabetes
Preeclampsia
Decreased fetal movement Past stillbirth
Multiple gestation
Oligohydramnios (low amniotic fluid) Post-term pregnancy (over 42 weeks)

Choice B:
IV initiation is not a routine part of BPP: Intravenous (IV) access is not typically required for a BPP. The test involves external monitoring of fetal heart rate and ultrasound imaging, which do not necessitate IV access.

Choice C:
NPO status is not necessary: The client does not need to be NPO (nothing by mouth) for a BPP. There are no dietary restrictions or fasting requirements for this test.

Choice D:
BPP does not determine the estimated date of birth: The primary purpose of the BPP is to assess fetal well-being, not to determine the estimated date of delivery (EDD). The EDD is typically established based on the last menstrual period or early ultrasound measurements.

Choice A:

While rupture of fetal membranes is a potential risk with placenta previa, it's not the primary reason to avoid a pelvic exam. If the membranes are already ruptured, a pelvic exam may be necessary to assess cervical dilation and fetal station.

However, in the absence of ruptured membranes, the risk of profound bleeding outweighs the benefits of a pelvic exam in women with placenta previa.

Choice C:

Preterm labor is a potential complication of placenta previa, but it's not directly caused by a pelvic exam. If preterm labor is suspected, a pelvic exam may be necessary to assess cervical dilation and fetal station.

However, in the absence of preterm labor signs, a pelvic exam is not routinely recommended in women with placenta previa due to the risk of bleeding.

Choice D:

Infection is a potential risk with any invasive procedure, including a pelvic exam. However, it's not a major concern in women with placenta previa compared to the risk of bleeding.

Proper sterile technique during the exam can significantly reduce the risk of infection.

Choice B:

Profound bleeding is the most significant risk associated with a pelvic exam in women with placenta previa. The placenta is located abnormally low in the uterus, covering or partially covering the cervix. Any manipulation of the cervix, such as during a pelvic exam, can disrupt the placenta's attachment and cause significant bleeding.

This bleeding can be life-threatening for both the mother and the fetus. Therefore, it's crucial to avoid pelvic exams in women with placenta previa unless there's a compelling clinical reason to perform one.