The nurse has reviewed the client's chart.

Exhibits

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

The nurse recognizes that this client is 

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due to 

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Correct choices;

Gravida 5, para 5 (G5P5)

This means the client has been pregnant 5 times and has given birth 5 times. Multiparity (having had multiple pregnancies and deliveries) is a risk factor for PPH due to uterine overdistension, which can lead to poor uterine tone and difficulty in contracting effectively after delivery.

Delivery of a 9 lb 1 oz (4.1 kg) baby

Larger babies are associated with an increased risk of PPH. The weight of the baby suggests a potentially larger placental surface area and increased uterine distension during pregnancy, which can contribute to uterine atony post-delivery.

Labor for 25 hours

Prolonged labor can lead to uterine exhaustion, where the uterus may not contract effectively after delivery, predisposing the client to PPH.

Forceps-assisted delivery

Instrumental deliveries, including forceps, can cause trauma to the birth canal, including the cervix, vagina, and perineum, increasing the risk of lacerations and bleeding.

Epidural anesthesia

Epidurals can mask the pain associated with uterine atony, which may delay the diagnosis of PPH. It's important to closely monitor uterine tone and blood loss in clients who have had epidurals.

4th degree laceration

Explanation: A 4th degree laceration involves the perineum and extends through the anal sphincter complex. Such extensive trauma increases the risk of significant bleeding postpartum.

Estimated blood loss of 600 mL

Although this is within the normal range of blood loss immediately after delivery, it still signifies that the client has experienced significant hemorrhage, putting her at higher risk for ongoing bleeding.

Rationale

A. Evacuation centers often accommodate a large number of people in close proximity. This can lead to increased transmission of infectious agents, including those causing diarrheal illnesses, through person- to-person contact or contaminated surfaces.

B. Hurricanes can cause flooding, which may overwhelm sewage systems and lead to contamination of drinking water sources. Consuming water contaminated by sewage can introduce pathogens that cause diarrheal diseases, such as bacteria like Escherichia coli or viruses like norovirus.

C. Flood waters can contaminate food supplies in various ways, such as direct contact with contaminated water, improper storage, or inadequate cooking or refrigeration. Consuming

contaminated food can result in diarrheal illnesses due to ingestion of pathogens like bacteria or parasites.

D. Nosocomial infections refer to infections acquired in healthcare settings. In a disaster medical area, improper infection control practices or overcrowding can contribute to nosocomial transmission of infectious agents, including those causing diarrheal diseases. However, this option is less likely in the context of a client seeking treatment for diarrhea immediately upon arrival at the disaster medical area.