During her first prenatal visit to the clinic at 7 weeks' ...

[P68T]

During her first prenatal visit to the clinic at 7 weeks' gestation, a 24-year-old primiparous patient comments, My blood type is A negative, and my husband's blood type is B positive.
 
  Will that cause problems with my pregnancy? The nurse's best response would be: 1. There is no danger to your baby, but there could be a few minor complications for you. Let's talk about what we can do to prevent those.
  2. We will do a blood test to see whether your body is responding to the baby's blood type. If so, we will give the baby some medication to prevent harm.
  3. Because your partner is positive and you are negative, there is some risk to the baby, but because this is your first pregnancy, the risks are very small.
  4. If you were O negative, you might have ABO incompatibility because of your partner's blood type; but since you are type A, there should be no problem.

Question 2

The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught and says, I should have known that something was wrong. Why didn't I see that he was so sick? The nurse's best reply is:
 
  1. Newborns have immature immune function at birth, and illness is very hard to detect.
  2. Your mothering skills will improve with time. You should take the newborn class.
  3. Your baby didn't get enough active acquired immunity from you during the pregnancy.
  4. The immunity your baby gets in utero doesn't start to function until he is 48 weeks old.

[jsm54321]

Answer to Question 1

3
Rationale 1: This patient is at risk for Rh incompatibility because she is Rh-negative and the father of the baby is Rh-positive.
Rationale 2: It is recommended that a Coombs' blood test be drawn to assess for antibody formation at the first prenatal visit and again at 28 weeks. Rh immune globulin (RhoGAM) will be given to the mother (not the fetus) at 28 weeks.
Rationale 3: This client is at risk for Rh incompatibility because she is Rh-negative and the father of the baby is Rh-positive. Because this is her first pregnancy, it is extremely unlikely that she has been exposed to Rh-positive blood, which would stimulate the development of antibodies. These antibodies cross the placenta and cause fetal hemolysis, which can lead to severe anemia that could cause fetal loss. It is recommended that a Coombs' blood test be drawn to assess for antibody formation at the first prenatal visit and again at 28 weeks. Rh immune globulin (RhoGAM) will be given to the mother (not the fetus) at 28 weeks, and again after delivery if the baby is Rh-positive, to prevent antibody formation.
Rationale 4: This is not an issue of ABO incompatibility.

Answer to Question 2

1
Rationale 1: The immune system of a newborn lacks response to pyrogens, and presents a limited inflammatory response; thus the signs and symptoms of infection are often subtle and nonspecific.
Rationale 2: This response does not address the physiology of neonatal infection, and is not therapeutic, because it is blaming.
Rationale 3: The mother develops active acquired immunity, which is passed to the newborn transplacentally as passive acquired immunity. This immunity is to the illnesses and infections she has had or been immunized against.
Rationale 4: The passive acquired immunity a newborn receives from its mother is effective at birth, and lasts from 4 weeks to 8 months, depending on the specific antibody.