OB SR nurs316l 2020 answers sr ob answers sr ob answers PDF

Preview

Summary

OB SR Patients nurs316l 2020 answers sr ob answers sr ob answers nurs316l 2020 sr answers sr ob patients answers...

Description

Jenny Smith Room 301 Jenny Smith, 23-year-old, G2P1, estimated gestation age of 10 weeks with complaints of vaginal bleeding and abdominal cramping. No medical hx, allergic to sulfa drugs. Lab results showed a decreased serum HCG from previous result. No fetal movement seen by ultrasound and no fetal heart tones could be obtained. Pelvic exam revealed an open cervical os with blood noted. She states that her pain is abdominal cramping, rates it from a 4/10 to a 7/10 and is still having vaginal bleeding. She has pain medication prescribed q4h prn and received a dose about 1 hour ago with some relief. Her vitals are stable at 98.1o F., Heart rate 89 bpm, 18 breaths/minute, 132/68 mmHg, O2 Saturation 98% on room air. She’s currently NPO until the need for dilation and curettage is ruled out. She has an IV in her left forearm, no fluids infusing at this time. She verbalized understanding of the findings and is visibly upset. She expresses concern about her family dealing with the loss and how she will tell them. She has been speaking with the staff about loss and is receptive to education regarding the next steps.

You responded correctly to 5 out of 6 evaluations: Category Educational Needs Fall Risk Health change

Your response Increased acuity Normal acuity Increased acuity

Explanation Jenny will need education regarding dealing with the loss both mentally and physically. She may be at increased fall risk related to bleeding, pain, and pain medication. She needs to be monitored for hemorrhage from the vaginal bleeding.

Category Pain level Physiological Needs Sensorium Needs

Your response Increased acuity Increased acuity Normal acuity

Explanation The client rates their pain at 7/10. Client is grieving a loss and expresses concern about herself and others coping. No issues reported here.

Physiological Description Acute Pain Altered family processes Anxiety Bleeding Decreased cardiac output Depression, risk for Grieving Ineffective airway clearance Ineffective coping Infection, risk for Nausea Suicidal ideations Safety

Description Fall, risk Impaired communication Impaired mobility Knowledge deficit

Your Response Explanation True Client rates pain 7/10 pain. False Roles have been changed due to the loss. True Client is expressing anxiety over loss. True Client is still having vaginal bleeding. False Vitals are stable, no signs of cardiac compromise. True Client has not relayed any feelings of depression. True Client is currently grieving a loss. False There are no reports of airway compromise. True Client seems to be coping so far, expresses feelings and respondin True Client is at risk for infection is miscarriage is incomplete. False Client no reports of nausea. False Client has not expressed thoughts of suicide.

Your Response True False False True

Explanation Client may be a fall risk due to pain medication, pain, and bleeding. Client is able to express feelings at this time with staff. Client has no mobility issues have been identified. Expresses uncertainty about how to explain loss to others, resources should a

Your Correct order order Step 2 1 Use therapeutic communication and express that you are here to listen if she wishes to talk. 3

2

1

3

4

4

5

5

Your order

Explanation Therapeutic communication should always be used. The nurse shou case she does feel like talking. She might open up if given time. Sta include “It sounds like you were looking forward to growing your fam ultrasound had shown better news.” Assess her overall condition and Assess the condition of patient to ensure that she is stable to be left vital signs if available. time. Respect her wish to be alone at It is normal in the grieving process to not wish to speak to others for this time and ask if there is anyone stable and has not opened up so should be left alone. A call to a frie member may assist. Important to return to support the client. to call/reassure you will return. Ensure that call light in reach and Always make sure the patient has access to call for help and is safe leave the room. Document the conversation. Documentation should be completed for the physician and other sta should be done last to include all the information needed. Correct order Step Explanation

2 1 Assess vital signs. Assessing vital signs will ensure the patient is stable and that its ok to give pain meds. If vitals are abnormal it could indicate complications. 4 2 Assess amount of current vaginal bleeding. ncreased pain could be caused by active miscarrying so bleeding should be assessed first. Immediate action will need to be taken if she is bleeding excessively. 3 3 discomfort.

Administer pain medication as prescribed

She has prn pain medication that she has been needing and using to relieve

1

4 Educate about spontaneous miscarriage and about medication action and effects and evaluate understanding. Always educate patients about the medications they have received and what they can expect after taking them.

5

5

Document event in the chart. It is important to document all that you’ve done for other providers to reference.

Your Correct order order Step 3 1 Assess vital signs. 1

2

2

3

4

4

5

5

Explanation An elevated temp, high heart rate, and/or low bp could be signs of compli need to be reported to provider. Assess vaginal bleeding Increased bleeding could indicate an incomplete miscarriage. This needs t amount and odor. quickly. It is important to have some point of reference to determine how significa Estimate and compare previous and current blood are in bleeding amounts. loss. Notify the healthcare The healthcare provider needs to be given a detailed description of the pa provider. data should be gathered prior to calling. The nurse should anticipate the n IV fluids and to check hemoglobin. Document findings and Documentation should be done last to include all the information. notification of healthcare provider.

Your Correct order order Step 1 1 Explain to Jenny about the plan of care. 2 2 Ensure that the consent is obtained prior to the surgery. 3

3

4

4

5

5

Explanation The client needs to be educated on the plan of care.

Obtaining the patient’s consent should always be done first. If th surgery or have questions for the provider then you would not p interventions. Assess NPO status to ensure that she If the patient has not been NPO long enough, the surgery may b has been NPO for the proper period of allow sufficient time to pass. If it is determined that she needs to NPO status, anesthesia will need to be made aware of her last fo time. Administer pre-op medications as Pre-operative medications are generally given within 1 hour of s indicated. Give report to the operating room staff OR staff receiving the patient needs to be given a full report prio and ensure support is given to the her care including NPO status, the surgical consent, and pre-op

Your Correct order order

Step client related to perinatal loss.

Your Correct order order Step 2 1 Assess Jenny’s current vital signs. 3 4

2 3

Assess current bleeding. Assess current urinary output.

1

4

5

5

Speak with Jenny and inform her that she is back in her room and that she is doing well. Assess her current pain level. Inform Jenny that her family is waiting and offer to bring them in to be with her.

Your Correct order order Step 1 1 Assess Jenny’s current status/physical readiness for discharge. 4 2 Verify blood type. 3 3 Educate about follow-up with provider. 2 4 Educate about warning

Explanation Support should be provided in a caring and sensitive manner du loss.

Explanation Vital signs should be checked quickly and regularly post-op to allow for you and to note any subtle changes that may indicate a problem Bleeding needs to be checked regularly as an increase can indicate Urine output would indicate hydration status and significance of est and cardiovascular stability. Client should void prior to discharge. Jenny should be updated about her status and be made comfortable important assessment but is normal after surgery so can be checke things which could indicate issues. The client has the choice to see family members and who she wants not have disclosed the pregnancy or may not want to see all family members may be updated as soon as possible but only after you ha patient and determined that they are stable.

Explanation Vital signs, bleeding, pain, and ability to void should be assessed for stability discharge. If she is Rh- she would need Rh immune globulin prior to discharge. She should see her provider in 1-2 weeks to ensure safe physical recovery, a either birth control or planning next pregnancy if she expresses desire to try She should know when to call provider- for fever, increasing pain, or excessiv

Your Correct order order 5

5

Step signs of complications. Offer support for pregnancy loss.

Explanation be able to “teach back” explain warning signs in her own words. Let her know that grief after a pregnancy loss may take time, that there may she is especially sad, like her due date (when she expected to be having a ba her partner may not grieve the same way, to reach out for support from frien sources as needed (counselor, support group, on line resources).

Kesha Jackson Room 302 Kesha Jackson, Patient is a G1P0, gestational age of 33.1. She came in complaining of contractions for 2 hours that are now every 5 mins. She is unsure about rupture of membranes, denying vaginal bleeding and recent intercourse. She states the baby is active. She rates her pain an 8/10. Her current vital signs are 98.1 F, 36.7 C, 92 BPM, 16 breaths/min, 122/64 mmHg, 99% on room air. The fetal heart rate is 135 baseline but is not yet reactive. Cervical exam reveals that she is not dilated or effaced, and the baby’s head is not engaged in the pelvis. She has no medical history and NKA. In obtaining her history, it was learned that she is 15 years old, currently homeless, and has been staying with various friends. She does have some supplies including diapers, wipes, and some clothing that she received from a friend. She expresses the desire to take her baby home with her. She is receptive to teaching and assistance she just has been unsure of how to obtain it. She came to the OB triage via a bus.

You responded correctly to 5 out of 6 evaluations: Category Educational Needs Fall Risk Health Change Pain Level Psychological Needs Sensorium

Your response Explanation Increased Status Assessment reports Kesha will need a lot of education regarding preterm labor precautions, resources for assist acuity her baby once it arrives Normal acuity Status Assessment reports Client is at increased of fall due to changing center of gravity and balance. Increased Status Assessment reports in addition to the pregnancy, there are now additional health issues due to the preterm lab acuity Increased Status Assessment reports she rates her pain an 8/10 acuity Increased Status Assessment reports Kesha is homeless, is pregnant, is a teen with developing coping mechanisms, and has a la acuity support system. Normal acuity Status Assessment reports no issues reported here.

Saftey

Description Fall Risk Ineffective health maintenance

Your Response Explanation True Status assessment reports Client is pregnant with a changing center of gravity increasing risk for falls. True Status assessment reports Client has limited resources and several barriers to h healthcare.

Description Infection Knowledge Deficit

Your Response Explanation False Status assessment reports no signs of infection noted. True Status assessment reports Client does require teaching about resources, childc labor plan of care.

Psychological

Description Anxiety Impaired home maintenance Noncompliance Risk for impaired parenting Physiological

Description Acute Pain Decreased cardiac output Impared Mobility Nausea Risk for nutritional imbalance

Your Response Explanation True No indication True Status assessment reports Client is currently homeless and with limited resource False True

Status assessment reports she has been complaint and is willing to learn and per necessary steps to get help. Status assessment reports Kesha has limited resources and is an adolescent with support system.

Your Response Explanation True Status assessment rates pain 8/10 False Status assessment reports status does not reflect issues with cardiac output at this ti True False True

Status assessment reports No mobility issues have been identified. Status assessment reports No reports of nausea. Status assessment reports adolescents who are pregnant are at higher risk for nutriti due to supporting their growth as well as fetal growth.

Your Correct order order Step 5 1 Assure that the monitor is tracing fetal heart rate consistently. 2 2 Adjust fetal heart rate monitor. 3 3 Give mother some cold juice to drink. 1 4 Reposition mother to left lateral position. 4

5

Request ultrasound for biophysical profile.

Explanation It is important to make sure that you are tracing FHR and not maternal, an is consistent. There could be accels that are not showing up due to an inco interrupted tracing. Adjusting FHR monitor can allow for clearer tracing and may also stimulate might aid in obtaining accelerations. Cold, sugary drinks will often increase fetal heart rate and activity. It is imp already established a good tracing. Repositioning mother results in fetal repositioning which may increase acc However, it often makes tracing more difficult so should not be done befor more efficient interventions. A biophysical profile can assess overall fetal status if NST is not reactive or to maintain/other interventions to obtain NST ineffective. It is more time co expensive so should not be used before other interventions.

Your Correct order order Step 1 1 Assess FHR and contraction pattern per monitor. 2

2

3

3

4

4

5

5

Perform sterile cervical exam to determine dilation, effacement, and station. Obtain urinalysis and lab work such as CBC. Administer IV fluids and/or antibiotics. Consider administration of tocolytics.

Explanation The presence of contractions is an indicator of preterm labor. It is im the frequency and intensity of contractions. It is always imperative t status to assess fetus. A sterile cervical exam will reveal how advanced the preterm labor is cervical change is present, magnesium sulfate for neuroprotection a should be considered. Obtaining Urinalysis and lab work can point to potential causes for p as dehydration or infection. This will guide your treatment. Administering fluids and/or antibiotics would be determined after an lab work have been completed and have pointed to a potential caus Tocolytics should be considered if other interventions have failed. Th potential side effects from tocolytics than fluids and antibiotics. Toco

Your Correct order order

Step

Explanation less effective if the cause is infection or dehydration

Your Correct order order Step 1 1 Educate Kesha about steroids and the need to administer them. Verify that she understands the rationale to receive the medication using the teach back method. 3 2 Verify the 5 rights of medication administration. 2 3 Prepare steroids as ordered by the healthcare provider. 4 4 Choose large muscle for injection and offer ice to site. 5 5 Establish a plan with Kesha to receive the second required dose of steroids in 24 hours. If discharged, she may have trouble getting transportation and need assistance. Your Correct order order Step 2 1 Use therapeutic communication. 1 2 Allow her to express her feelings and concerns. 3 3 Ask open ended questions to further develop the conversation. 4 4 Answer any questions openly and offer support.

Explanation Patients should always be educated before being gi medication. They should have an understanding of side effects and reasons for giving it and express th and consent prior to administration. The 5 rights should always be verified prior to giving The medications should be given after education, co rights have been completed. Steroid injections should be given deep IM and may should be offered. Steroids should be given in 2 doses, 24 hours apart. establish a means for Kesha to get her second dose previous steps.

Explanation Therapeutic communication should always be used when speakin It is important to allow her to express herself and explain what sh After the initial communication by the patient, attempt to develop further by asking open ended questions and see if she has more t Answering questions and providing more information is important a teachable moment. Offer support for her and encouragement a

Your Correct order order Step 5 5 Document the conversation.

Explanation Documentation should be done last to include all elements of the

Your Correct order order Step Explanation 2 1 Use therapeutic communication Therapeutic communication should always be used when speak techniques. 1 2 Assess her cognitive level and readiness It is important to assess the readiness and cognition level of a p to learn. beginning teaching so that the information can be presented in manner and at the appropriate time. Information should be provided in a clear manner so that it is e 3 3 Discuss referral to social work/case management. Provide clear information Written materials should be provided to allow them to have som along with printed material that she can later and to reiterate the teaching. She is receptive to assistanc include transportation, equipment, and finances, among other r take with her. 5 4 Allow her to ask any questions that she Questions should be allowed and answered after the teaching h may have after teaching is complete. so the patient can clarify anything they did not fully understand 4 5 Evaluate her understanding of the After any teaching is completed, it is important to evaluate the information provided using proven understanding of the information provided. techniques such as teach-back or return demonstration.

Jennifer Humes Room 302 Jennifer Humes, 30-year-old Caucasian female, G4 T2 P0 A1 L2, 33 5/7 weeks gestation. History of chronic hypertension and gestational hypertension with this pregnancy. Nifedipine XL 30 mg daily. NKDA. Previous pregnancies uncomplicated with NSVDs. One spontaneous abortion at 10 weeks gestation. Woke up early morning feeling wet; wasn’t sure if leaking urine or membranes ruptured. Turned on light and it was blood. Asked a neighbor to come over to watch other children and husband brought her to hospital. They are

making phone calls to get family member to come and take care of 5 and 2-year old children. Anxious about this pregnancy and bleeding too. Has mild abdominal pain and contractions.

You responded correctly to 4 out of 6 evaluations: Category Educational Needs Fall Risk Health change Pain level Physiological Needs Sensorium Needs

Your response Increased acuity Normal acuity Increased acuity Normal acuity Increased acuity Normal acuity

Explanation Status assessment reports r/t change in condition. Status assessment reports r/t 34 weeks gestation and pain, change in center of gravity. Status assessment reports r/t complication of pregnancy and bleeding. Status assessment reports r...