A nurse is caring for a client who is pregnant. The nurse is reviewing the client's medical record.

Exhibits

Select 4 findings that indicate a potential prenatal complication

Rationale:

• Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
• Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
• Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.
• Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
• Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.

Rationale:

A. “Dehydration is treated with calcium supplements.": Calcium supplementation is not a standard treatment for dehydration. Dehydration is primarily managed with fluid replacement, either orally or intravenously, depending on severity.

B. "Dehydration is caused by a decreased hemoglobin and hematocrit.": Dehydration often causes increased hemoglobin and hematocrit levels due to hemoconcentration, not a decrease. These lab values are used to assess hydration status but do not cause dehydration.

C. "Dehydration is associated with gastroesophageal reflux”: GERD is not a direct cause or result of dehydration. While fluid intake can influence GI symptoms, GERD and dehydration are unrelated conditions with different pathophysiologies.

D. "Dehydration can increase the risk for preterm labor”: Dehydration can trigger the release of antidiuretic hormone and oxytocin, both of which may lead to uterine contractions. It is a recognized risk factor for preterm labor and should be addressed promptly.