The practical nurse (PN) is assisting the registered nurse (RN) in caring for a client with placenta previa who is at 31-weeks gestation.
Which method should the PN use to most accurately estimate blood loss?

Choice A rationale

Giving prescribed digoxin and furosemide is part of the long-term management for cardiac conditions, but these medications do not provide immediate relief for an acute hypoxic spell. Digoxin improves cardiac contractility, and furosemide promotes fluid excretion, but their onset of action is not rapid enough for emergent situations.

Choice B rationale

Returning the child to bed and elevating the head of the bed might provide some comfort but does not directly address the underlying physiological cause of the hypoxic spell. Elevating the head of the bed may slightly improve respiratory effort but won't reverse cyanosis effectively.

Choice C rationale

Offering to play a board game with the child as a distraction does not address the physiological emergency of a hypoxic spell. Distraction may be helpful for anxiety but is not an intervention for cyanosis, tachypnea, and tachycardia, which require medical intervention.

Choice D rationale

Providing oxygen increases the available oxygen for gas exchange, and promoting the knee-chest position reduces venous return to the heart, thereby decreasing right-to-left shunting and improving pulmonary blood flow in conditions like Tetralogy of Fallot, which commonly presents with "squatting" and hypoxic spells.

Choice A rationale

Observing for any changes in nail bed color is crucial for assessing capillary refill and circulation distal to the cast. Pallor, cyanosis, or prolonged capillary refill (normal <2 seconds) can indicate impaired blood flow or nerve compression, signs of compartment syndrome, requiring immediate medical attention to prevent permanent tissue damage.

Choice B rationale

Allowing the child to return to school after only one day's rest is generally not advisable immediately after cast application. The initial 24-48 hours are critical for observing for swelling, neurovascular compromise, and managing pain. Rest and elevation are typically recommended to minimize edema formation.

Choice C rationale

Wrapping the cast in a plastic bag when the child takes a shower is important to prevent the cast from getting wet. A wet cast can soften, lose its supportive integrity, and promote skin maceration and infection underneath. Moisture can also lead to skin irritation and breakdown.

Choice D rationale

Giving the child a dose of acetaminophen as prescribed for pain is important for pain management, but it is not the most important home care information. While essential for comfort, it does not address the critical neurovascular assessment needed to prevent severe complications like compartment syndrome.