A nurse is caring for a client who is incontinent of urine. Which of the following actions should the nurse take?

A. Wrap the sleeve loosely around the client's lower leg: The sleeve should fit snugly but comfortably to ensure effective compression. Wrapping it too loosely reduces efficacy in promoting venous return and preventing deep vein thrombosis. Proper fit is essential for device function and patient safety.

B. Measure the circumference of the client's upper leg: Measuring the thigh circumference ensures the correct sleeve size is selected, which is crucial for effective compression and prevention of pressure injury. Accurate sizing allows the device to deliver appropriate pressure without causing discomfort or circulatory compromise.

C. Turn on the mechanical unit prior to applying the sleeve: The device should remain off until the sleeve is properly positioned on the client. Activating it beforehand may result in improper inflation, skin injury, or ineffective compression. Turning it on too early can also startle the client and reduce comfort.

D. Position the client prone to apply the device: The client should be supine or with legs slightly elevated when applying a thigh-length sequential compression device. Prone positioning is unnecessary, uncomfortable, and can complicate proper sleeve placement. Supine positioning facilitates correct alignment and device effectiveness.

Rationale for correct choices:

• Placental abruption: The client exhibits sudden-onset hypertension, epigastric pain, headache, and facial edema at 30 weeks gestation, which are risk factors for placental abruption. Abruption involves premature separation of the placenta from the uterine wall, leading to maternal and fetal compromise. Early recognition is critical due to potential hemorrhage, fetal distress, and preterm delivery.

• Hypertension: The client’s blood pressure readings (148/94 mm Hg and 156/96 mm Hg) are significantly elevated for gestation, indicating preeclampsia or gestational hypertension. Hypertension increases the risk for placental abruption by causing vascular injury and reduced placental perfusion.

Rationale for incorrect choices:

• Postpartum hemorrhage: Postpartum hemorrhage occurs after delivery and is not a risk during the antepartum period at 30 weeks. While abruption can lead to bleeding, postpartum hemorrhage specifically refers to hemorrhage after birth and is not directly indicated by current findings.

• Placenta previa: Placenta previa involves implantation of the placenta over or near the cervical os, often presenting with painless vaginal bleeding. The client reports epigastric pain, headache, and hypertension, which are not characteristic of placenta previa.

• Hyperreflexia: While hyperreflexia is noted (DTRs 3+ bilaterally) and may indicate preeclampsia, it is a clinical finding rather than a direct cause of placental abruption. It is an important assessment parameter but does not independently increase the risk of abruption.

• Vomiting: Vomiting is a symptom the client reports but is not a primary risk factor for placental abruption. It may indicate associated preeclampsia or general discomfort but does not contribute directly to vascular placental separation.