Provide rationale, citation and reference for all answers.

Scenario

  1. H. Is a 34-year-old multigravida patient who wants to use the Basal Body Temperature method of the Fertility Awareness methods of birth control because she is “becoming older” and wants a less invasive method of birth control. D.H. desires more information about Basal Body Temperature method of birth control. Explain BBT method of birth control to include indications, reliability, risks, benefits, and how to use this method.

 

 

 

  1. H. at 37 years old comes to the clinic stating, “I think I may be pregnant. I haven’t had a period in 10 weeks, my breasts are tingling, and I don’t fit into my jeans.” Based upon this information, what type of Signs of Pregnancy is this client experiencing?

 

 

  1. This is her fifth pregnancy. She has two children 8 and 3 at home both term deliveries (still living). Other pregnancies were spontaneous abortions. What is the GP and GTPAL based upon her maternal history?

 

  1. An ultrasound is done at the initial visit and confirms that the client is 7 weeks pregnant. What type of ultrasound was performed (using the number of weeks as a guide to determine the appropriate type)?

 

  1. What instructions would have been given to the client prior to the ultrasound being performed?

 

  1. The client states that her last period began on 2 March. Using Naegel’s rule, what is the expected date of delivery?

 

 

  1. H. has an uneventful perinatal history. Then, at her 38 week prenatal appointment the nurse assesses the following: weight 176 lbs (increase of 10 lbs in one week); swelling in her hands, feet, and face; edema +2; blood pressure of 142/94 mmHg; pulse 88 bpm; edema +2; deep tendon reflexes +2; no clonus; proteinuria +2 (on urine dip); negative urine glucose; frontal headache with eases with acetaminophen. She states the light is too bright while shielding her eyes. What other questions should a nurse ask the patient at this time?
  2. What laboratory values should be considered at this time?
  3. What are the risk factors for preeclampsia (all of them)? Identify the risk factors that this patient has for preeclampsia?
  4. What are three possible complications with preeclampsia?
  5. Write the priority physiologic nursing diagnosis for this client (what is the most important safety need)? Write a goal for this diagnosis.

 

 

 

  1. H. is admitted to labor and delivery for a labor induction with pitocin. Describe the procedure for pitocin induction.
    1. What are the nursing responsibilities for safe administration of pitocin?

 

  1. What are three potential complications?

 

  1. H. complains of increasing headache, proteinuria is +3, and DTR’s are +3. Vital signs include Bp 154/94 mmHg, pulse 92. What is the primary concern based upon this assessment?

 

 

  1. The physician orders magnesium sulfate infusion 4-gram bolus over 30 minutes, then 2 gm per hour. The pharmacy sends up an IV bag of 1-liter Lactated Ringers with 40 mg magnesium sulfate for a secondary line. Describe the procedure for magnesium sulfate infusion.
    1. What is the purpose for administering this medication?

 

 

  1. At what rate will the bolus be administered in mL/hr?

 

  1. Describe the adverse effects of magnesium sulfate administration.

 

 

  1. What are the nursing responsibilities for safe administration of MgSO4?

 

 

  1. H. is being induced for labor for the past 2 hours and her cervix is 5 cm/ 80%/ 0 station. Membranes are ruptured for one hour of light yellow, colored amniotic fluid.

 

  1. Review the stages of labor. What stage is D.H. in at this time based on the above information?

 

  1. The obstetrician orders internal monitoring of the fetal heart rate and placement of an intrauterine pressure catheter to monitor contractions. Below is the tracing after 30 minutes of monitoring.

 

  1. What is the FHR?
  2. Describe the variability.
  3. If there are any decelerations, what type is present?
  4. What is the frequency of contractions?

 

  1. What are the most appropriate nursing interventions at this time?

 

 

  1. If calling the physician was on the list of appropriate nursing interventions, write out an SBAR to the physician at this time.

 

 

  1. H. elects to have epidural anesthesia to relieve the discomfort of labor. Following the initiation of epidural anesthesia, what is the nurse’s priority action?
    1. Checking for cervical dilation
    2. Placing the client in a supine position
    3. Checking the client’s blood pressure
    4. Obtaining a fetal heart rate

 

 

 

  1. H. delivers via a cesarean section 2 hours later an 8-pound 8-ounce girl, with APGAR of 4 and 8 and the infant is transferred to the nursery.

 

 

  1. Describe the immediate newborn care for the first hour of infant life.

 

 

 

Postpartum Focus

  1. H. is transferred to the postpartum unit after recovering from surgery. Magnesium sulfate is infusing at 2 gm/hr piggybacked into her mainline of normal saline. In a secondary sight, pitocin is infusing. She has received pain medications. What are the nurse’s priority assessments for this patient?

 

 

  1. A boggy uterine fundus is noted upon assessment. Write the priority nursing diagnosis for H at this time.

 

 

 

  1. Plan care for D.H. based upon the priority NDx:
    1. What is the goal for this diagnosis?
    2. Include three nursing interventions that will resolve or relieve the problems with rationale.
    3. What additional medication and method of delivery can be anticipated at this time?

 

Newborn Focus

  1. The infant at 1 hour of age is without respiratory distress and has been assessed with the New Ballard Score. The infant is determined to be LGA. What does this mean? What plan of care would a nurse develop to best care for this infant?

 

  1. Explain to the father of the baby about the medications that the baby will receive upon admission to the nursery.

 

  1. The mother plans to breastfeed and is able to express colostrum. Describe the benefits of colostrum.

 

  1. A student nurse asks, “When will the milk come in?” Explain to the student the process of milk production and information about lactation that the mother will need to know.

 

  1. On the day of discharge, the infant’s skin color is yellow colored down to the chest area. A bilirubun level drawn in the morning was 8 dl. Describe the discharge instructions that should be given to the parents regarding this condition. (Start with what the condition is called.)

 

  1. On the day of discharge the infant is taken to the nursery for the Universal Newborn Screening and Newborn Hearing Screening. Explain to the parents the reason these are done.

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