The nurse is reviewing prenatal charts. A client at 24 weeks has ...

[hbsimmons88]

The nurse is reviewing prenatal charts. A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?
 
  1. Dyspnea and chest pain with mild exertion.
  2. Elective cesarean birth scheduled for 37 weeks.
  3. Discussed need for labor epidural and vacuum extraction.
  4. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally.

Question 2

A nurse is caring for a newborn of a diabetic mother. Which of the following should be included in the nurse's plan of care for this newborn?
 
  1. Offer more frequent feedings.
  2. Provide glucose water exclusively.
  3. Evaluate blood glucose levels at 12 hours after birth.
  4. Assess for hypothermia.

[nicoleclaire22]

Answer to Question 1

3
Rationale:
1. Dyspnea and angina with mild exertion are not expected with class II heart disease even during pregnancy, but are symptoms seen in class IV heart disease.
2. Cesarean birth is only undertaken in cardiac patients for fetal or maternal intrapartal indications, not for cardiac reasons alone.
3. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth.
4. 3+ pre-tibial edema is never an expected finding during pregnancy. Pulse over 100 and respiratory rate over 24 are indicators of cardiac decompensation.

Answer to Question 2

1
Rationale:
1. Newborns of diabetic mothers can require more frequent feedings.
2. If normal levels of glucose cannot be maintained, the newborn might require intravenous infusions of D10W, along with oral feedings, to maintain normoglycemia.
3. Blood glucose levels should be checked hourly during the first four hours and then at four-hour intervals until the risk peak has passed. Hypothermia is more common in SGA newborns, due to diminished subcutaneous fat.
4. Onset of hypoglycemia occurs 13 hours after birth.