1. A nurse in the emergency department is assisting with the care of a client who is 19 years old and is at 18 weeks of gestation.

Exhibit 1

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Correct Answers:

Condition: B Actions to take: B, C
Parameters to monitor: B, D

Rationale:
Condition:

A.    Hydatidiform mole is associated with abnormal trophoblastic tissue growth in the uterus, but the scenario in the question does not provide evidence to suggest a hydatidiform mole.
B.    Hyperemesis gravidarum is characterized by severe nausea, vomiting, weight loss, and electrolyte imbalance during pregnancy.
C.    Gestational diabetes mellitus is a condition characterized by impaired glucose tolerance during pregnancy. The symptoms described in the scenario (severe nausea and vomiting) are not indicative of gestational diabetes.
D.    Ectopic pregnancy is not consistent with the symptoms described in the scenario.
Ectopic pregnancy typically presents with abdominal pain, vaginal bleeding, and signs of shock, but not with prolonged severe nausea and vomiting.
Actions to take:

A.    Hyperemesis gravidarum is primarily managed with conservative measures such as dietary changes, antiemetic medications, and intravenous hydration. Surgery is not a standard treatment for hyperemesis gravidarum.
 
B.    Inspect mucous membranes for signs of dryness, cracking, or bleeding. This will help to assess the severity of dehydration
C.    Severe vomiting can lead to dehydration and electrolyte imbalance, so establishing IV access is crucial for fluid and electrolyte replacement.
D.    Monitoring the fundal height helps assess fetal growth and well-being but is not a priority in this case.
E.    Daily fetal movement counts are more relevant in the later stages of pregnancy, usually in the third trimester. In the case of hyperemesis gravidarum, the primary concern is maternal dehydration and electrolyte imbalance rather than fetal well-being. Parameters to monitor:
A.    Keihauer-Betke values are not relevant to hyperemesis gravidarum. Keihauer-Betke testing is typically used in cases of Rh incompatibility, especially in the context of assessing the need for Rh immune globulin administration.
B.    Hyperemesis gravidarum can lead to electrolyte imbalances, particularly hypokalemia. Monitoring electrolyte levels is essential for managing and preventing complications.
C.    While gestational diabetes mellitus involves monitoring blood glucose results, it is not the primary concern in hyperemesis gravidarum. Hyperemesis gravidarum focuses on managing severe nausea, vomiting, and dehydration.
D.    Monitoring urine ketones helps assess the degree of dehydration and metabolic derangement due to prolonged vomiting.
E.    Serum human chorionic gonadotropin (hCG) levels are monitored in hydatidiform mole and not hyperemesis gravidarum.