ATI RN Maternal Newborn 2023 IV | Nurselytic

Extract:

A nurse is caring for a client at the next prenatal visit. Vital Signs:
Initial visit, 1330:
• Heart rate 110/min
• Respiratory rate 18/min
• Blood pressure 104/66 mm Hg
• Temperature 36.6° C (97.9° F)
• Oxygen saturation 99% on room air
9-week visit, 0955:
• Heart rate 116/min
• Respiratory rate 20/min
• Blood pressure 92/50 mm Hg
• Temperature 36.5° C (97.7° F)
• Oxygen saturation 97% on room air
Nurses' Notes
29-year-old gravida 2, para 0 client presents with report of a positive home pregnancy test from 2 weeks ago. Last menstrual period was 7 weeks ago. Urine human chorionic gonadotropin (hCG) test positive. Client reports vomiting several times a day over the last 2 weeks and states, "I'm a vegetarian and I don't usually eat a lot of protein, but it's still hard to keep anything down." Decreased skin turgor noted, oral mucous membranes moist. Weight 79.4 kg (175 lb).
9-week visit, 1000:
Client returned to clinic for follow-up visit after initial prenatal appointment 2 weeks ago. Client reports continued nausea and recurrent episodes of vomiting every day. Has been unable to complete work or sleep well at night due to nausea and vomiting.
Poor skin turgor with tenting noted. Oral mucous membranes dry. Urine reagent strip results of large amount of ketones. Client tearful, reassurance provided. Weight today is 77.6 kg
Laboratory Results
• WBC count 7,500/mm3 (5,000 to 10,000/miny Hgb 10.2 g/dL (11 to 16 g/dL)
• Hct 45% (33% to 47%)
• Platelets 360,000/mm3 (150,000 to 400,000/mm3)
• Sodium 136 mEq/L (136 to 145 mEq/L)
• Potassium 3.3 mEq/L (3.5 to 5 mEq/L)
• BUN 28 mg/dL (10 to 20 mg/dL)
Urinalysis:
• Appearance clear (clear)
• Color dark amber yellow (pale yellow amber)
• pH 7.9 (4.6 to 8)
• Protein 4 mg/dL (0 to 8 mg/dL)
• Specific gravity 1.045 (1.005 to 1.03)
• Leukocyte esterase negative (negative)
• Nitrites none (none)
• Ketones large (none)
• Bilirubin none (none)
• Glucose none (none)
History and Physical
9-week visit, 1030:
Client is primigravida at 9 weeks of gestation. No significant medical or surgical history. Now reports continued vomiting, has lost 1.8 kg (4 lb) since prior visit. Mucous membranes dry, poor skin turgor, and ketonuria noted. FHR 156/min via Doppler ultrasound. Recommended admission to antepartum unit for treatment of hyperemesis gravidarum.

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