The emergency department nurse is assessing a 14-month-old child who was left inside a closed car for an hour. The outside temperature was 88 degrees Fahrenheit. Which assessment findings will the nurse report immediately to the health care provider? Select all that apply.

Choice A reason: Discussing screening for diabetes is appropriate as pre-diabetes in a newly pregnant patient requires careful monitoring and management to prevent the development of gestational diabetes. Early detection and intervention can improve outcomes for both the mother and the baby.

Choice B reason: A one-hour glucose test is typically part of the gestational diabetes screening process, but it is not necessary to fast overnight specifically for the initial discussion and planning. The timing and preparation for specific tests will be guided by the healthcare provider.

Choice C reason: Eliminating sugar from the diet can be part of managing pre-diabetes, but it is not the immediate response to finding pre-diabetes in a newly pregnant patient. A more comprehensive approach will be discussed with the primary care provider.

Choice D reason: A three-hour glucose tolerance test is a diagnostic test for gestational diabetes, which may be recommended later if initial screening results warrant it. It is not typically performed immediately without prior discussion and planning with the healthcare provider.

The correct order is: b, a, d, c

1. b) Position the patient in a supine position: The first step is to ensure the patient is in a supine position, which is lying on their back. This position provides the best access and visibility for the nurse to assess the fundus effectively. Ensuring the patient is comfortable and relaxed in this position is crucial before beginning the assessment.
2. a) Place one hand on the lower segment of the uterus: The next step involves placing one hand on the lower segment of the uterus. This helps to stabilize the uterus and provides support while the nurse palpates the fundus. It also prevents any excessive movement that could cause discomfort or complications.
3. d) Press at the level of the umbilicus to palpate the fundus: The nurse then presses at the level of the umbilicus (belly button) to palpate the fundus. The fundus is the top portion of the uterus, and assessing its position and firmness provides important information about the postpartum recovery process.
4. c) Gently massage the fundus in a circular motion: Finally, the nurse gently massages the fundus in a circular motion. This action helps to ensure the uterus remains firm and can help in preventing postpartum haemorrhage. If the fundus is not firm, the massage can stimulate uterine contractions to firm it up.