A nurse is caring for a 30-year-old gravida 4, para 3 client at 30 weeks gestation diagnosed with complete placenta previa who presents to the emergency department with bright red vaginal bleeding. Her vital signs are: BP 100/60 mmHg, HR 110 bpm, RR 22/min, temperature 98.4°F. Fetal heart rate is 130 bpm with moderate variability. The client reports feeling dizzy but denies abdominal pain or contractions. Ultrasound confirms complete placenta previa with the placenta completely covering the cervical os. Which nursing intervention should be the priority?

Complete bed rest with bathroom privileges and avoiding vaginal exams is the priority to prevent further hemorrhage in placenta previa. Other interventions like preparing for delivery or administering IV fluids are important but secondary to preventing exacerbation of bleeding.

Clinical Judgment
The core of this problem is preventing manipulations that can cause dangerous bleeding. The patient has been diagnosed with complete placenta previa and has bright red, painless vaginal bleeding. Current vital signs are stable, and the fetal heart rate is within normal range. This means it is not a situation requiring immediate emergency surgery. Therefore, the priority is to avoid worsening the current condition, buy time for fetal maturation, and maintain maternal and fetal stability. Bed rest and prohibition of vaginal exams in option 1 are the most direct and immediate interventions to prevent additional bleeding by blocking all physical stimulation to the placental site.

Memory Tip:
Remember the core principle of managing placenta previa bleeding as the No Touch Policy (NTP). Prohibiting all vaginal/cervical manipulations, such as vaginal exams, sexual intercourse, and tampon use, saves lives.

KR vs US
In Korea, there is a tendency to focus more on immediate blood transfusion preparation and vital sign monitoring during placenta previa bleeding. In contrast, the US NGN/CJMM emphasizes "Prevention" and "Risk Recognition," stressing that the first thing to do is to avoid creating a dangerous situation. In other words, "what not to do" is the key point in determining priorities.

Clinical Practice Guide
The basic principles of managing a patient with placenta previa hemorrhage are as follows:
1. Absolutely prohibited: Digital Vaginal Exam. This can cause massive hemorrhage.
2. Bed Rest: Bathroom use is allowed, but activities like walking or standing are restricted.
3. Continuous Monitoring: Frequently assess vital signs, amount of bleeding, and fetal heart rate (FHR).
4. Preparation: Secure an IV line, laboratory tests (including blood type and crossmatch), and prepare for blood transfusion and emergency cesarean section.
5. Position: Generally, a left lateral position is recommended, and the Trendelenburg position is not recommended (as the uterus may compress the vena cava, reducing fetal blood flow).

Caution:
A common trap in SATA (Select All That Apply) questions is "what to report immediately." In a placenta previa patient, sudden bleeding accompanied by pain should raise suspicion for Abruptio Placentae. This must be distinguished from the 'painless bleeding' in this case.