A nurse is teaching a class on the different types of uterine ...

[cool]

A nurse is teaching a class on the different types of uterine bleeding. Abnormal uterine bleeding accounts for 5 to 10 of the cases in an outpatient setting. The nurse explains the abnormal uterine bleeding can be caused by:
 
  1. Iron-deficiency anemia.
  2. A disruption in the normal cyclic hormonal pattern of ovulation to the lining of the uterus.
  3. Heavy periods every 2 months.
  4. Spotting between periods.

Question 2

The charge nurse is reviewing charting on patients in the maternal-child triage unit. Which entry requires immediate intervention?
 
  1. Primip at 24 weeks diagnosed with polyhydramnios: Patient reporting shortness of breath.
  2. Multip at 32 weeks: Oligohydramnios per ultrasound secondary to fetal renal agenesis.
  3. Primip at 41 weeks: Patient reports leaking clear fluid from her vagina for 7 hours.
  4. Multip at 34 weeks diagnosed with oligohydramnios: Cervix 6 cm, -2 station, up to walk in hallway.

[Chou]

Answer to Question 1

2
Rationale 1: Iron-deficiency anemia is a symptom of abnormal uterine bleeding, not a cause.
Rationale 2: Disruption in the normal cyclic hormonal pattern of ovulation to the lining of the uterus is one of the main causes of abnormal uterine bleeding.
Rationale 3: Heavy periods every 2 months could be one of the symptoms of abnormal uterine bleeding, not a cause.
Rationale 4: Spotting between periods is a symptom of abnormal uterine bleeding, not a cause.

Answer to Question 2

4
Rationale 1: Although this patient is uncomfortable, shortness of breath often accompanies polyhydramnios. It can require removal of some amniotic fluid through amniocentesis to facilitate comfort, but this is not a life-threatening emergency.
Rationale 2: Renal agenesis will lead to oligohydramnios because of the lack of fetal urine production. This patient will be grieving, but is not experiencing physical complications.
Rationale 3: Leakage of clear fluid is normal; leaking for several hours can lead to oligohydramnios, which in turn can lead to variable decelerations.
Rationale 4: Active labor in a preterm multip with the presenting part high in the pelvis is at high risk for prolapse of the cord when the membranes rupture. This patient should be on bed rest until the membranes rupture and the presenting part has descended well into the pelvis. This patient is at greatest risk for physical complication (cord prolapse), and therefore is the highest priority.

[cool]

Excellent

[mohan]

Gracias!