A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected?

A. Strict intake and output monitoring is important for managing any patient with significant blood loss or who is at risk for complications, but it does not directly address the immediate needs of a client with abruptio placentae. The priority is stabilizing the mother and delivering the fetus safely.

B. Prepare for delivery of the fetus by cesarean section (C/S) is correct. Abruptio placentae (placental abruption) is a life-threatening condition where the placenta prematurely detaches from the uterine wall, leading to bleeding and potential fetal distress. Immediate delivery is often required, especially if there is significant bleeding or fetal compromise. A cesarean section is usually the preferred method of delivery in these cases to reduce the risk of maternal and fetal complications.

C. Weekly monitoring of coagulation factors is important for managing coagulopathies that might develop in the presence of placental abruption, but it is not the immediate action required. Immediate delivery is the priority.

D. Complete bed rest for the remainder of the pregnancy may be recommended for certain cases of placental abruption with mild symptoms, but in the presence of moderate vaginal bleeding and significant findings on ultrasound, immediate delivery (typically by C-section) is more urgent.

A. A score of 7 would be given if the infant’s heart rate was 100, but with less than optimal responses for color, muscle tone, and respiratory effort. However, this baby demonstrates strong responses in all categories.

B. The Apgar score is calculated based on five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. The infant in the scenario has:

Heart rate of 100 (score 2)

Pink body and blue hands (score 1 for color—because the baby is not fully pink, indicating some cyanosis in the extremities)

Active motion (score 2 for muscle tone)

Strong lusty cry (score 2 for reflex irritability/responsiveness to stimuli)

Good respirations (score 2)

Adding these scores (2 + 1 + 2 + 2 + 2), the total is 8.

C. A score of 5 would indicate more significant distress, with poor color, respiratory effort, and muscle tone. This infant is showing good signs of adaptation.

D. A score of 9 would indicate that the baby has no signs of cyanosis and perfect responses in all categories, but since the infant has blue hands, it scores slightly lower (1 point less for color).