Question

A nurse at a provider's office is caring for a client who is 28 years of age

History and Physical
Day 1 at 1000:Gravida 3, Para 2, Abortion 1Asthma (managed with levalbuterol inhaler as needed)Pelvic inflammatory disease (PID)Spontaneous vaginal delivery X 2 (hypertension with first pregnancy at 20 years of age)Voluntary termination of pregnancy (3rd pregnancy)
Nurses' Notes
Day 1 at 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting.
Vital Signs
Day 1 at 1000:Temperature 37.2° C (98.9° F)Heart rate 90/minRespirations 16/minBlood pressure 120/74 mm HgOxygen saturation 97% room air
Day 1 at 1030:Te

Answer 1

Janine is given pitocin to stimulate labor due to being overdue and experiencing weak contractions with minimal cervical dilation. The newborn's first breath alters circulatory patterns by increasing lung blood flow and closing fetal shunts, establishing independent pulmonary circulation.

Step-by-step explanation:

Janine is 41 weeks pregnant and experiencing prolonged labor, which is why an IV infusion of pitocin is started. Pitocin is a synthetic form of oxytocin, a hormone that increases the strength and frequency of uterine contractions to progress labor. In Janine's case, this intervention is necessary to help her advance towards active labor, as she is past her due date and her contractions are mild and her cervix minimally dilated. The newborn's first breath dramatically changes the circulatory pattern by increasing the blood flow in the lungs and decreasing resistance in the pulmonary blood vessels. This causes the closure of fetal circulatory shunts and the redirection of blood flow, establishing the independent pulmonary circulation necessary for life outside the womb.