A nurse is monitoring a client who is 36 hr postoperative following gastric banding. Which of the following findings should the nurse expect?

Rationale for Correct Options:

• Placental abruption: This condition involves the premature detachment of the placenta from the uterine wall, often triggered by hypertensive disorders. The client’s elevated blood pressure (148/94 mm Hg), facial edema, and hyperreflexia point toward preeclampsia, a leading risk factor for placental abruption.
• Hypertension: Hypertension during pregnancy compromises uteroplacental blood flow, potentially causing vascular damage and leading to placental separation. The client’s reading reflects stage 1 hypertension, which, along with other signs, raises concern for placental complications such as abruption.

Rationale for Incorrect Options:

• Spontaneous abortion: Typically occurs before 20 weeks gestation, making it irrelevant for a client at 30 weeks. There are no signs of fetal loss or cervical dilation in this case.
• Placenta previa: Presents with painless vaginal bleeding in the second or third trimester. This client has no vaginal bleeding or placental misplacement.
• Chorioamnionitis: This infection would present with fever, uterine tenderness, and fetal tachycardia. The client is afebrile, has clear lung sounds, and shows no evidence of intrauterine infection.
• Oligohydramnios: Usually detected via ultrasound or significantly low fundal height. The client's fundal measurement (29 cm at 30 weeks) is appropriate, and there’s no mention of decreased amniotic fluid.
• Hyperreflexia: Although suggestive of preeclampsia, it is a secondary symptom that indicates neurologic involvement and seizure risk rather than directly causing placental abruption.
• Vomiting: While it may be associated with preeclampsia, it is non-specific and does not independently increase the risk of placental abruption without supporting findings like hypertension or abdominal pain.

A. Maintain bed elevation at 20°: The head of the bed should be elevated to at least 30° to 45° during enteral feedings to reduce the risk of aspiration. A 20° angle is inadequate for preventing reflux and potential aspiration.
B. Flush the tubing with 30 ml of water every 4 hr: Routine flushing of the feeding tube helps maintain patency and prevent clogging. Flushing every 4 hours is standard practice for continuous feedings to ensure uninterrupted delivery.
C. Place enough formula in the container to last 18 hr: Open system formula should be discarded after 4 hours to reduce the risk of bacterial contamination. Filling the container for 18 hours exceeds safe hang time recommendations.
D. Check for gastric residual every 12 hr: Gastric residuals should typically be checked every 4 to 6 hours for continuous feedings, or per facility policy. Waiting 12 hours may delay the identification of feeding intolerance or complications.