Patient with 20 weeks of pregnancy with history of bleeding reports at Sub Centre. Which of the followings sh… - Hariyana-CHO-2021

Hariyana-CHO-2021

Obstetrics & Gynaecology

Hard

Appeared in: Hariyana-CHO-2021

Explanation

The correct action is to immediately refer the patient to a First Referral Unit (FRU).
Bleeding in the second half of pregnancy could be due to placenta previa, where a vaginal examination can cause life-threatening hemorrhage.
A Sub Centre lacks the diagnostic (ultrasound) and treatment (surgery, blood transfusion) facilities required to manage this high-risk obstetric emergency.
The primary responsibility of a healthcare worker at a Sub Centre is to recognize the danger sign and ensure safe and prompt transfer to a higher facility.

Option A: Performing a PV (per vaginum) examination is strictly contraindicated in a patient with antepartum hemorrhage until placenta previa has been ruled out by ultrasound, as it can provoke massive bleeding.
Option C: 'PN examination' is not a standard medical term in this context, and no examination should take priority over or delay the urgent referral of a high-risk patient.
Option D: This option is incorrect because it includes performing a PV examination, which is a dangerous and contraindicated action in this clinical scenario.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Antepartum Hemorrhage (APH) in a primary healthcare setting to guide bedside assessment, documentation, and the next nursing action.
The core nursing principle in APH is 'hands off the vagina until the placenta is localized.' This is a critical patient safety rule in any setting, especially in primary and community health.
Nurses at peripheral centers must be skilled in recognizing obstetric danger signs, providing basic stabilization (if possible), and initiating a prompt and effective referral.
What if the patient was already at the FRU? The first step would still not be a PV exam. The first step would be to secure IV access, check vitals, and perform an emergency ultrasound to determine the cause of bleeding and location of the placenta.

How to Approach the Question

First, identify the key elements of the scenario: a pregnant patient (20 weeks), a danger sign (bleeding), and the setting (Sub Centre).
Recognize that bleeding after 20 weeks of pregnancy is Antepartum Hemorrhage (APH), a serious obstetric emergency.
Consider the limitations of the setting. A Sub Centre has minimal resources and cannot manage complex emergencies.
Recall the most critical safety precaution for APH: Do not perform a vaginal examination due to the risk of placenta previa.
Evaluate the options based on this safety principle. Any option suggesting a PV exam is incorrect.
Conclude that the only safe and appropriate action is to transfer the patient to a facility equipped to handle the emergency, which is the FRU.

Concept Tested & Keywords

Concept Tested: Management of Antepartum Hemorrhage (APH) in a primary healthcare setting.
Stem keywords: 20 weeks of pregnancy, history of bleeding, Sub Centre
Lead-in keywords: should be done
Clinical cues: The setting is a 'Sub Centre', which indicates limited resources and necessitates referral for complications.
Clinical cues: Bleeding at 20 weeks is classified as Antepartum Hemorrhage, a high-risk condition.

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E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 207-209