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©2
018Ke
it
hRi
sch
er/
www.
Kei
thRN.
com
Th
iss
tud
ysou
rcewa
sdown
loa
dedb
y10
000
083
353
271
7fr
omCou
rse
Her
o.c
omon0
1-1
9-2
0220
2:5
4:1
4GMT-
06:
00
,h
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s:/
/www.
cou
rse
her
o.c
om/
fi
le
/10
220
267
3/STUDENT-
Fet
al-
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tre
ss-
UNF
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x/
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cal
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pta
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ned1 5p ound
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gnancy
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ntr
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rso
nal
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ial
His
tor
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l
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s
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ya ndh a
sn oth
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ds ta
tesmon eyi
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ing
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steri
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iv
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Wh
atd
ataf
romt
heh
ist
ori
esa
reRE
LEVANTa
ndmu
stb
ein
ter
pre
teda
scl
i
nic
all
ysi
gni
fi
can
tbyt
hen
urs
e?
RELEVANTDa tafr
omPr esentProbl
em:Cl
in
ica
lSi
gn i
fi
canc e
:
403/7We eksgest
ati
on . Postdatedpregnan cyputheratari
skforc-
sectionandcomp l
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ca t
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Posi
ti
veforGroupBetaStrep/Recei
vi
ng withbaby.
ant
ibi
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cs. Babyha sariskforGr oupBetaStr
epinfe
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on.
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n a
ncywe i
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s
tat
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.
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alHist
ory
: Cli
nicalSi
gn i
fi
ca nce:
Sheli
vesal
oneandisnotinvol
vedwit
hthe Sheha sanincr
ea s
e driskforpos t
partumdepressi
onduet oalackof
fat
her. hel
pf r
omt hefather.
Unemployedandsmo kescigar
ett
es. Smokinghasar i
skofl owbirthweightandinc
reasedri
skofrespir
ator
y
Unheal
thydie
t. comp l
icat
ions.Herlac kofinc omelowe rsherabi
li
tytofina
ncial
ly
Didnotatt
endp r
enata
lclassesdueto supportherchi
ld.
tr
ansport
ati
onissues. In
creasedr i
skforma lnourishme ntforthebabyandh er
self
.
Knowledgedefi
citcanc ausec omplicati
onst
hroughoutherpre
gnancy
andnotp r
e par
eh erforb e
ingamot h er
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tie
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reBe
gin
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:
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9F/37.
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al) Prov
oking/Pal
li
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necontr
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ng
R:18(r
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on/Rad i
ati
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s
BP:118/
68 Sever
it
y: 5/
10
O2sat:9
8%RA Ti
ming: Wit
hute
rin
ec ont
rac
ti
ons
©2
018Ke
it
hRi
sch
er/
www.
Kei
thRN.
com
Th
iss
tud
ysou
rcewa
sdown
loa
dedb
y10
000
083
353
271
7fr
omCou
rse
Her
o.c
omon0
1-1
9-2
0220
2:5
4:1
4GMT-
06:
00
alDi
str
ess/
Cesar
eanSecti
on
UNFOLDINGReasoni
ng
L
uel
laJ
one
s,25y
ear
sol
d
Pr
imaryConcept
Perfu
sion
I
nte
rre
lat
edConce
pts(Inor
derofe
mph
asi
s)
Repr
oducti
on
Cli
ni
calJudgment
Col
lab
orati
on
Pati
entEducat
ion
Commu ni
cati
on
NCL
EXCl
ie
ntNe
edCa
tego
rie
s Per
cent
ageofItemsfr
omEach Cover
edin
Cat
egor
y/Subcat
egor
y CaseSt
udy
Sa
fea n
dE f
fec t
iv
eCa reEn vi
ronment
Mana gemento fCare 17-23%
SafetyandInfecti
onCon tr
ol 9-
15%
Heal
thPromo t
ionandMa i
ntenance 6-
12%
Ps
ychosoci
al I
ntegri
ty 6-
12%
Phy
siol
ogica
l In
tegri
ty
Basi
cCa r
ea ndCo mfort 6-
12%
Pharmacol
ogicalandPar
ent
eral
Ther
api
es 12-18%
Reduc t
ionofRiskPot ent
ial 9-
15%
©2
018Ke
it
hRi
sch
er/
www.
Kei
thRN.
com
Th
iss
tud
ysou
rcewa
sdown
loa
dedb
y10
000
083
353
271
7fr
omCou
rse
Her
o.c
omon0
1-1
9-2
0220
2:5
4:1
4GMT-
06:
00
,h
ttp
s:/
/www.
cou
rse
her
o.c
om/
fi
le
/10
220
267
3/STUDENT-
Fet
al-
Dis
tre
ss-
UNF
OLDI
NG-
Rea
son
ing
doc
x/
, Ph
ysi
ol
ogi
cal
Ada
pta
tion 1
1-1
7%
UNF
OLDI
NGRe
ason
ingCa
seSt
udy
Hi
sto
ryo
fPr
ese
ntPr
obl
em:
Lu
e l
l
aJ onesisa2 5
-year-
oldfemalepat
ie
ntG1 P0whoisc u
rren
tly403 /
7we ek
sg es
tatio
n .Sh
eisa dmit
tedtothehospi
tal
tobe
i
nducedforbeingpost-d
a t
e.Sheisposi
ti
veforGroupBetastr
eptococcusandrec
eivi
ngIVa nti
bi
oti
c sperpr
otocol
.Sheis65
i
nches(162.5cm).Herp r
e-pr
egnancyweigh
twa s115pou n
ds(52 .
3k g
).Shegai
ned1 5p ound
s(6.8k g
)d u
ringt
hispre
gnancy
.
Shejus
thads ponta
ne ousrupt
ureofmemb r
ane swi
thamod erat
ea mountofthi
ckme coniu
mf l
uid.Thenurseperf
ormeda
va
g i
nalch
e ck,andhercervi
xisdil
ate
dto4c m, 8pe
rcenteff
aceda nd-1st
ati
on.Pit
ocinisinf
usin
ga t6mU/ min
u t
e
i
ntr
avenously.
Pe
rso
nal
/Soc
ial
His
tor
y:
L
ue l
l
aliv
esalon
ea ndisnolonge
rinvolve
dwi t
hthefat
he rofherbaby.
He rfamil
ysupporti
sli
mitedtoherol
dersi
st
er.She
s
mok esonepackofciga
rett
esad a
ya ndh a
sn oth
adaj obforoverayea ran
ds ta
tesmon eyi
stig
h t
.Sheadmit
stonoteat
ing
v
eryhealt
hydur
ingthepreg
n a
ncybeca us
eitiseasi
ert
og r
abch i
psandp opthancook.Shemissedafewofherpre
natal
visi
ts
duetotr
ansp
ortat
ioni
ssuesanddidn otat
tendanypre
na talc
lasses
.He rsi
steri
sp r
esentashersuppor
tper
sonduri
nglaboran
d
del
iv
ery.
Wh
atd
ataf
romt
heh
ist
ori
esa
reRE
LEVANTa
ndmu
stb
ein
ter
pre
teda
scl
i
nic
all
ysi
gni
fi
can
tbyt
hen
urs
e?
RELEVANTDa tafr
omPr esentProbl
em:Cl
in
ica
lSi
gn i
fi
canc e
:
403/7We eksgest
ati
on . Postdatedpregnan cyputheratari
skforc-
sectionandcomp l
i
ca t
ion
s
Posi
ti
veforGroupBetaStrep/Recei
vi
ng withbaby.
ant
ibi
oti
cs. Babyha sariskforGr oupBetaStr
epinfe
cti
on.
Preg
n a
ncywe i
ghtgai
nof1 5lbs. Shed i
dn otgainen oughwe i
ghtt
hroughherpregnanc
y.Theb abycoul
dbe
Spont
aneousruptur
eo fmemb ra
nes ma l
nourishe
d.
(meconi
umf l
uid)
. Thebabycanaspi
rat
eme coni
umandle
adtore
spi
rat
orycompl
i
cat
ion
s.
Cerv
ixdil
ate
d4c m, 8
%e ffa
ce dand-1 Laborismov i
nga longwi t
hthehelpofPit
oci
n.
s
tat
ion
.
RELEVANTDa tafromSo ci
alHist
ory
: Cli
nicalSi
gn i
fi
ca nce:
Sheli
vesal
oneandisnotinvol
vedwit
hthe Sheha sanincr
ea s
e driskforpos t
partumdepressi
onduet oalackof
fat
her. hel
pf r
omt hefather.
Unemployedandsmo kescigar
ett
es. Smokinghasar i
skofl owbirthweightandinc
reasedri
skofrespir
ator
y
Unheal
thydie
t. comp l
icat
ions.Herlac kofinc omelowe rsherabi
li
tytofina
ncial
ly
Didnotatt
endp r
enata
lclassesdueto supportherchi
ld.
tr
ansport
ati
onissues. In
creasedr i
skforma lnourishme ntforthebabyandh er
self
.
Knowledgedefi
citcanc ausec omplicati
onst
hroughoutherpre
gnancy
andnotp r
e par
eh erforb e
ingamot h er
.
Pa
tie
ntCa
reBe
gin
s:
Curr
entVS: P-Q-R-S-TPa i
nAs se
ssment
:
T:99.
9F/37.
7C(or
al) Prov
oking/Pal
li
ati
ve: Uteri
necontr
act
ions
P:90(r
egul
ar) Qual
ity
: Sev
erecr
amp i
ng
R:18(r
egul
ar) Regi
on/Rad i
ati
on: Lowpel
vi
s
BP:118/
68 Sever
it
y: 5/
10
O2sat:9
8%RA Ti
ming: Wit
hute
rin
ec ont
rac
ti
ons
©2
018Ke
it
hRi
sch
er/
www.
Kei
thRN.
com
Th
iss
tud
ysou
rcewa
sdown
loa
dedb
y10
000
083
353
271
7fr
omCou
rse
Her
o.c
omon0
1-1
9-2
0220
2:5
4:1
4GMT-
06:
00
