A woman presents to the clinic in the first trimester of pregnancy.

She has three children living at home.

One of them was born prematurely at 34 weeks.

The other two were full-term at birth.

She has a history of one miscarriage.

How do you record her obstetric history on the chart using GTPAL format?

Choice A rationale

This statement is incorrect as caloric needs increase during pregnancy to support fetal growth, placental development, and increased maternal metabolic demands. Inadequate caloric intake can lead to poor fetal outcomes, including low birth weight and impaired development.

Choice B rationale

While caloric needs do increase, an additional 500 calories is generally too high for the average pregnancy. The recommended increase is typically lower, focusing on nutrient-dense foods to ensure sufficient energy for both mother and fetus.

Choice C rationale

Doubling caloric intake is excessive and can lead to excessive maternal weight gain, increasing risks for gestational diabetes, preeclampsia, and delivery complications. The concept of "eating for two" is a common misconception that often leads to overconsumption.

Choice D rationale

During the second and third trimesters, the average pregnant woman requires an additional 300 calories per day above her pre-pregnancy needs. This increase provides adequate energy for rapid fetal growth, development, and maternal physiological changes, such as increased blood volume and uterine expansion.

Choice A rationale

Notifying the healthcare provider immediately and requesting antibiotics is premature. Slight redness around pin sites without drainage or pain, and stable vital signs, does not immediately indicate a significant infection requiring systemic antibiotics. This initial finding warrants a thorough assessment and local care before escalating to medical intervention.

Choice B rationale

Removing crusting around pin sites can be detrimental. Crusting can serve as a protective barrier. Aggressive removal can introduce bacteria into the pin tract, increasing the risk of infection, or cause unnecessary pain and trauma to the delicate healing tissue. Gentle cleansing is preferred over forceful removal of adherent crusts.

Choice C rationale

Cleansing the pin sites using sterile saline and assessing for signs of infection is the best immediate action. Slight redness without drainage is often a normal inflammatory response to the foreign body and movement. Sterile saline effectively cleanses without irritating the tissue, and continued assessment helps monitor for evolving signs like increased redness, purulent drainage, or fever.

Choice D rationale

Documenting findings as normal and continuing routine assessments is insufficient. While slight redness can be normal, it still requires diligent monitoring and appropriate pin site care to prevent potential complications. Assuming normalcy without active intervention like cleansing could allow a minor irritation to progress to a more serious infection. .