Maternal Newborn Scenarios Renee Workman

Renee WorkmanRoom301 Renee Workman,Renee Workman, 35-year-old African American female, G2 T0 P0 A1 L0, 36 weeks gestation, history of In Vitro Fertilization with one failed implantation. Otherwise uncomplicated pregnancy. Reported decreased fetal movement today. BP of 144/92 in ofÏce. Weight up 2 kg in 2 weeks since last appointment. Urine +1 protein on dipstick. Mild headache and slightly blurry vision. No contractions, leaking of fluid or vaginal bleeding. Wife accompanies client. You responded correctly to4out of6evaluations: Category Educational Needs Fall Risk Health Change Pain Level Psychological Needs Sensorium Your response Increased acuity Increased acuity Increased acuity Increased acuity Increased acuity Normal acuity Status Assessment Status Assessment Status Assessment Status Assessment Status Assessment Status Assessment reports reports reports reports reports reports r/t r/t r/t r/t r/t r/t Exp potential diagnosis/preecl 36 weeks gestation/chang potential complication of headache. decreased fetal movemen no evidence of changes in Renee Workman Renee Workman, 35-year-old African American female, G2 T0 P0 A1 L0, 36 weeks gestation, history of In Vitro Fertilization with one failed implantation. Otherwise uncomplicated pregnancy. Reported decreased fetal movement today. BP of 144/92 in ofÏce. Weight up 2 kg in 2 weeks since last appointment. Urine +1 protein on dipstick. Mild headache and slightly blurry vision. No contractions, leaking of fluid or vaginal bleeding. Wife accompanies client. You correctly diagnosed9out of10options: Saftey Description Fall Risk Injury, risk for maternal Physiological Your Response True True Your Description Response Deficient Fluid True Volume Imbalanced False Nutrition Injury, risk for fetal True Injury, risk for True maternal Nausea False Love and Belonging Your Description Response Anxiety True Disabled Family False Coping Health Maintenance True Explan Status assessment reports r/t shifting center of gr Status assessment reports r/t risk for worsening p seizures. Explanat Status assessment reports r/t fluid shift from intravascu potential preeclampsia. Status assessment reports no evidence of this is status nutrition. Status assessment reports r/t uteroplacental insufÏcien preeclampsia. Status assessment reports r/t hypertension and vasosp preeclampsia. Status assessment reports no evidence of nausea in the Explanat Status assessment reports r/t unknown impact of pree Status assessment reports no evidence. Wife accompa Financial Concerns Status assessment reports r/t deficient knowledge abo management Renee WorkmanScenario2 Assessment data: T 36.5 C, 97.2 F, Pulse 88 and regular, BP 150/94 R arm, 148/96 L arm. Baseline FHR 144. Reactive NST with no fetal decelerations. Heart sounds regular, no heart murmur or extra sounds. Breath sounds clear bilaterally +3 peripheral edema, +3 reflexes. States pain level 5/10“headache increasing”. Labs are ordered and drawn, and intravenous access is obtained. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step Exp 1 1 Turn the client to her left side Left lateral recumbent position decreases p and offer prescribed venous return and placental and renal perfu acetaminophen. 2 2 Elevate and pad side rails. Her DTRs are +3 so she has slightly hyperre rails protects her from injury if she has a se 3 3 Apply oxygen at 10 L/min per Minimal fetal variability may be related to fe mask. mother increases perfusion to fetus. Reactiv cycle but oxygen to mother won’t harm and 4 4 Emergency medications Magnesium sulfate, calcium gluconate, hyd brought to the client’s “toolbox” and brought to client’s room for im room/verify accessibility. before calling HCP, anticipating one or more depends upon agency policy. 5 5 Notify healthcare provider of After doing all of these interventions to help assessments. healthcare provider of the status change. Renee WorkmanScenario3 The healthcare provider orders labs including a 24-hour urine for protein and creatinine. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered6out of6actions: Your Correct order order Step 1 1 Post signs and in the EHR/plan of care regarding the 24-hour urine collection. 2 2 Ask the client to void and discard the urine. 3 3 Place the urine in a special container or on ice. 4 4 Collect all urine in the next 24 hours. 5 5 6 6 Ask the client to void and save the urine. Label and send the urine specimen to the lab. Important to notify everyone involv urine is collected. The specimen collection begins wit discarded. The time is noted as the A special container is obtained from specimen needs to be kept on ice. Total volume of urine is part of the must be saved. If there is a spill or and results are delayed. At the 24-hour mark, the client is a doesn’t feel the urge to void). The All lab specimens must be correctly results as soon as possible. Renee WorkmanScenario4 The nurse reviews the lab reports and notifies the HCP and gives report in SBAR. SELECT THE FIRST TWO NURSING ACTIONS (situation (S) and background (B))IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step 1 1 Renee Workman, blood work results reveal HELLP syndrome. 2 2 Renee is 36 weeks gestation, came to clinic today due to decreased f movement. 3 3 NST reactive but minimal variability. BP ranging 148-160/96-100. +3 HA and blurry vision remain. 4 4 What magnesium sulfate loading dose and infusion rate would you lik start Renee on? 5 5 Read back HCP prescription: Magnesium Sulfate 4-gram loading dos minutes followed by 2 gram/hour. Renee WorkmanScenario5 Ten (10) minutes into the magnesium loading dose infusion the client states “I feel so hot I can’t stand it!” Her spouse says, “Look how red her face is! What is happening? I’m so scared!” SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: Not all responses will be used. You correctly ordered1out of6actions: Your Correct order order Step 5 1 In a calm voice, remind the client and her wife that this is an expected side effect of the magnesium sulfate related to vasodilation. 1 2 Use therapeutic touch and dim the lights in the room. 2 3 Provide the client with a cool washcloth for her forehead; cover the client with sheet only and offer a fan. 3 4 Assess the client’s vital signs and document FHR. 4 5 Ask the wife to leave the client’s room. 6 6 Notify the healthcare provider of the adverse effects of the medication. (not used) Important the nurse re Flushing is an expected Therapeutic touch dem decrease stimuli and se Applying the cool cloth help to decrease enviro be completed quickly b Calming and cooling cl signs are less impacted documented q 15 minu Presence of 1 or 2 supp Asking her wife to leav Flushing is an expected healthcare provider do