A nurse in an obstetrics clinic is caring for a client.
Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again.
Exhibit 1
Nurses’ Notes
Initial visit, 1340:
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) 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).
Exhibit 2
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
Continuation of above exhibit
Exhibit 3
The nurse is reviewing the client’s assessment findings and laboratory results.
Laboratory Results
Initial visit, 1600:
WBC count 7,500/mm3 (5,000 to 10,000/mm3)
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 (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)
The Correct Answer and Explanation is:
In this scenario, the findings that require follow-up are:
- Heart rate 110/min: This elevated heart rate is outside the normal range for a pregnant client, who typically has a heart rate between 60 to 100 beats per minute. An increased heart rate in pregnancy can be a sign of several issues, including dehydration, anemia, or other underlying conditions that need further investigation.
- Hgb 10.2 g/dL: This hemoglobin level is below the normal range (11 to 16 g/dL). In pregnancy, anemia is a common concern and can be caused by various factors such as increased blood volume, nutritional deficiencies, or underlying health conditions. Anemia can lead to fatigue, decreased oxygen delivery to tissues, and other complications. This finding warrants further evaluation and possible intervention.
- Potassium 3.3 mEq/L: This potassium level is below the normal range (3.5 to 5 mEq/L). Hypokalemia (low potassium levels) can be associated with dehydration, excessive vomiting, or other issues. Low potassium levels can cause symptoms such as muscle weakness, fatigue, and cardiac irregularities, which may require supplementation or dietary adjustments.
- BUN 28 mg/dL: This blood urea nitrogen (BUN) level is above the normal range (10 to 20 mg/dL). Elevated BUN can indicate dehydration, impaired kidney function, or high protein intake. In the context of vomiting and potential dehydration, this finding suggests that the client’s hydration status may need to be addressed.
- Urinalysis – Specific gravity 1.045: This is above the normal range (1.005 to 1.03), indicating concentrated urine. This finding is consistent with dehydration, which is likely exacerbated by the client’s vomiting and difficulty maintaining adequate fluid intake.
Explanation:
- Elevated Heart Rate: A heart rate of 110 beats per minute, while not excessively high, is worth noting, particularly in the context of pregnancy. Elevated heart rates can be a response to dehydration or other stressors on the body. It is crucial to assess the client’s overall hydration status and other symptoms.
- Anemia (Low Hemoglobin): Anemia is common during pregnancy due to increased blood volume and iron demands. It can cause fatigue, dizziness, and other symptoms. Anemia needs to be managed to prevent complications for both the mother and the fetus. Dietary adjustments, iron supplements, or further evaluation might be necessary.
- Hypokalemia (Low Potassium): Potassium is crucial for maintaining cellular function, and low levels can lead to muscle weakness, cardiac issues, and other problems. Given the client’s symptoms of vomiting, potassium supplementation or dietary adjustments might be needed.
- Elevated BUN: Elevated BUN often suggests dehydration or kidney issues. In this case, it aligns with the findings of concentrated urine and vomiting. Addressing the client’s fluid intake and monitoring renal function might be necessary.
- Concentrated Urine (High Specific Gravity): High specific gravity supports the idea of dehydration. This is particularly relevant given the client’s ongoing vomiting and difficulty keeping fluids down. Adequate hydration is crucial to prevent further complications.
Overall, these findings suggest that the client may be experiencing dehydration and anemia, likely exacerbated by severe morning sickness. The nurse should address these concerns promptly, potentially including rehydration, electrolyte management, and further assessment of anemia.