Ectopic Pregnancy Darlene Case Study Test with complete solutions
Darlene goes to ER at 0615. Reports that she was awakened in the night w/ serious pain
... [Show More] in her RLQ accompanied by N/V. Admission assessment reveals: 98.4F; 80; 20; 126/68, pain 9/10 LMP "about a month ago". Her HR is reg and lungs CTAB. Palpation of the abd elicits c/o pain at RLQ. Her husband James is at her bedside. He suspects that his wife is having an appendicitis attack and is concerned that no US or blood tests have been done.
Which tes (s) does the RN anticipate that the HCP will order after considering Darlene's hx and sx?
Based on her sx, the HCP orders a UA, urine preg test, CBC and serum hCG. The results:
Her HCG is 2550 mU/mL and her urine preg test returns as positive
Based on the provided results, the RN can infer which of the following?
What is the fxn of HCG?
The HCP in the ED discusses the results of the lab tests w/ Darlene and her husband James and explains that Darlene has a + preg test. After the HCP leaves the room, Darlene looks at the RN and states, "That can't be. I have been having my period. How can I be preg?"
What would be the RN's appropriate response to the client
The RN notes that Darlene's HCG level is 2550 mU/mL and nest asks Darlene a series of questions, including when her LMP was, if she smokes, and if she has ever had any STIs. Darlene reports her LMP was 5 wks ago and that she had chalymdia 6 yrs ago
Why does the RN ask Darlene these questions?
Using Naegele's Rule, what is the EDD?
A pelvic exam and transvaginal US are preformed and an adnexal mass and tendersness in the RLQ are noted. Soon after the exam, she c/o that the pain is shooting to her right shoulder. Based on the pelvic exam and transvaginal US findings, a low-risk ectopic preg is dx'd and no cardiac activity is detected.
How should the RN explain ectopic preg to Darlene and James?
Based on the dx of a low-risk ectopic preg w/ no cardiac activity, the need to discuss tx options arises. James is very eager to become a father and asks if the ectopic preg has ruined their chance of becoming preg again.
Which is the best way for the RN to respond?
The RN gives Darlene and James some time to process all that they have learned in the short time they have been in the hospital. She asks them if they have any questions. Darlene says "My sister just had a miscarriage. Does that mean she had chlamydia or any other STIs?"
How should the RN respond to Darlene?
When James hears the word abortion, he becomes upset. He states that he was raised to believe that abortion is wrong. The RN spends some time teaching some basic medical terminology to them
What is the correct terminology for a situation in which the non-viable preg is not expelled?
Which term is used to describe the condition when a preg woman experiences increased vaginal bleeding and cramping, her internal cervical os dilates, and the membranes may rupture?
The HCP discusses Darlen's status w/ her and James. After the HCP leaves, James states, "I still don't like th word abortion. Can't an abortion be called a miscarriage? In order to validate his feelings, the RN states that the term miscarriage is the lay's term for spontaneous abortion. She then calmly introduces a more in-depth discussion about the different types of spontaneous abortions
Which stmt by the couple indicates that they need further teaching?
The RN states that she is very sorry that the couple has to make such a difficult decision and reiterates to the couple the HCPs discussion about interventions that must occur or Darlene's life will be in danger. Implantation of a fertilized ovum in the fallopian tube puts a client at risk for rupture of the fallopian tube, internal hemorrhage, shock, and death. The couple , after a few private moments, decides to remove the ectopic pregnancy
What is the best response by the RN to the couple regarding their decision to remove the ectopic preg?
Now that the couple has made their decision, what does the RN anticipate the HCP to prescribe initially for tx? [Show Less]