With stable vital signs and fetal heart rate, priority is IV access and blood preparation for potential hemorrhage, not immediate delivery. Other options (Trendelenburg, vaginal exam) are contraindicated.
심화 해설
Clinical Judgment
This question evaluates RECOGNIZE CUES and PRIORITIZATION. The key cue is "34 weeks, painless bright red vaginal bleeding, complete placenta previa". This means the placenta completely covers the cervix, making vaginal delivery impossible, and the continuous bleeding is a life-threatening situation for both mother and fetus. The priority is to remove the source of the bleeding, which is immediate cesarean delivery. At 34 weeks gestation, the fetus is viable, and the risk from continuous bleeding outweighs the risk of preterm complications.
Memory Tip: The key keywords for placenta previa are "Painless" and "Previa". It is characterized by painless bleeding, and a Vaginal Exam is an Absolute Contraindication.
KR vs US: In Korea, when placenta previa is diagnosed, conservative treatment may be attempted depending on gestational age and bleeding amount, such as strict bed rest in the hospital and medication (tocolysis, steroids) to promote fetal lung maturity and delay delivery. However, in NGN/US exams, when there is active bleeding, immediate cesarean delivery is presented as the standard priority nursing intervention rather than conservative treatment.
임상 시나리오
Clinical Practice Guide
The core principles of managing placenta previa are to avoid triggering bleeding, stabilize the maternal condition, and deliver safely at the appropriate time.
1. Absolute contraindications: Digital vaginal exam, use of vaginal ultrasound probe, sexual intercourse.
2. In case of active bleeding: Immediate preparation for cesarean section is the top priority.
3. In case of inactive/minimal bleeding: Hospitalization, strict bed rest, fetal monitoring, steroid administration (to promote lung maturity), and preparation of blood products may be carried out.
Caution: In SATA (Select All That Apply) questions asking "nursing interventions needed for a patient with placenta previa," "performing a vaginal exam" is never included. "Trendelenburg position" is also generally avoided as it can impair uteroplacental perfusion and cause respiratory difficulty. Instead, place the patient in the left lateral position.
학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.