A nurse is caring for a client who has hyperemesis gravidarum.
Which of the following laboratory tests should the nurse anticipate?

Choice A rationale

Applying constant firm pressure to the penis for five minutes if bleeding occurs is an appropriate initial intervention for bleeding after a circumcision. However, it does not address the routine care needed after each diaper change to promote healing and prevent infection.

Choice B rationale

Cleansing the penis gently with water after each diaper change removes urine and stool, preventing irritation and potential infection. Applying a thin layer of petroleum jelly around the glans helps to keep the diaper from sticking to the healing circumcision site, reducing discomfort and promoting healing.

Choice C rationale

Prepackaged diaper wipes often contain fragrances and alcohol, which can irritate the sensitive skin of a newly circumcised penis and potentially delay healing or cause discomfort. Gentle cleansing with water is preferred.

Choice D rationale

The yellow exudate that forms on the glans after circumcision is a normal part of the healing process, known as granulation tissue. It should not be washed off, as this can disrupt healing and increase the risk of infection. It will typically disappear on its own over a few days.

The nurse should monitor the client’s temperature due to the risk of chorioamnionitis.

Rationale for correct answers

Temperature monitoring is crucial for detecting chorioamnionitis, an infection of the amniotic sac, which is a major risk following preterm premature rupture of membranes (PPROM). PPROM increases susceptibility to ascending bacterial infection, leading to inflammation. Fever (>38°C or 100.4°F) is a primary diagnostic criterion.

Chorioamnionitis presents with maternal fever, fetal tachycardia (>160/min), uterine tenderness, and foul-smelling amniotic fluid. The client's normal temperature now (36.7°C) requires ongoing monitoring, as infection could develop rapidly.

Rationale for incorrect Response 1 options

• Magnesium levels: Magnesium sulfate is used for seizure prophylaxis in eclampsia or for neuroprotection in preterm labor. This client has no signs of either condition.
• Fundal height: Measurement assesses fetal growth and amniotic fluid levels; it is not a direct indicator of infection risk.
• Clotting factors: No evidence of coagulopathy or bleeding abnormalities; coagulation profile is normal.

Rationale for incorrect Response 2 options

• Concealed hemorrhage: No signs of placental abruption (painful bleeding, rigid abdomen). Normal hemoglobin (12.0 g/dL) supports this.
• Seizures: No hypertensive crisis or neurological symptoms suggestive of eclampsia.
• Disseminated intravascular coagulation (DIC): No abnormal coagulation markers or evidence of excessive bleeding.

Take-home points

• PPROM increases the risk of chorioamnionitis, a serious intrauterine infection. • Fever monitoring is essential, as maternal fever is an early indicator of infection. • Antibiotics are given prophylactically to reduce chorioamnionitis risk in PPROM. • Differentiation from placental abruption, eclampsia, and DIC is based on clinical and laboratory findings.