A woman with a history of previous abruptio placentae with fetal demise is being seen in the perinatal clinic. She is now pregnant again in her early second trimester
She tells the nurse she is a Jehovah's Witness and she wants her chart to reflect her refusal to accept blood products if she hemorrhages again. Which action by the nurse is best?
A.
Ask the woman to consider an exception in order to save her baby's life if needed.
B.
Document the information on the chart and inform the health-care provider.
C.
Encourage the woman and provider to discuss appropriate delivery sites.
D.
Tell the woman a court can order the transfusion to save the baby.
ANS: C
Jehovah's Witnesses do not accept blood products or their derivatives as part of their medical care. Because this woman is at high risk for a complicated pregnancy (another abruptio placentae) and hemorrhage, she should be advised to deliver in a tertiary care center that is prepared to manage catastrophic hemorrhage. The nurse should facilitate this discussion as part of providing holistic care. Asking the woman to reconsider (and go against her religious beliefs) is disrespectful. The nurse should document the information and inform the care provider, but this action in itself is incomplete. Telling the woman that a court can order her to have transfusions, although a true statement, is likely to be perceived as threatening and disrespectful, and certainly does not allow the nurse to provide care in a holistic manner.
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