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:

Answer 1

An IV infusion of pitocin is initiated for a woman at 41 weeks of pregnancy to induce labor due to prolonged pregnancy and lack of labor progression. The newborn's first breath prompts important changes in the circulatory system, transitioning from fetal to postnatal circulation. Concerns of potential pregnancy after unprotected sex right before ovulation are valid, and mid-cycle spotting may indicate implantation bleeding.

Step-by-step explanation:

Understanding Labor and Circulatory Changes in Newborns

A 41-week pregnant woman admitted to the birthing unit and started on an IV infusion of pitocin is likely experiencing prolonged pregnancy and labour induction is necessary to initiate or augment labor contractions. This is often done when there is concern about the pregnancy continuing well beyond the expected delivery date, or if there is a lack of progression in labour, as evidenced by minimal cervical dilation and infrequent contractions.

The newborn's first breath alters the circulatory pattern significantly. At birth, the infant's lungs expand, decreasing pulmonary vascular resistance and increasing blood flow to the lungs. This leads to the functional closure of fetal circulatory shunts like the ductus arteriosus and the foramen ovale, transitioning the newborn's circulatory system from fetal to normal postnatal circulation.

In the case of unprotected sex followed by mid-cycle pain indicative of ovulation, there is a valid concern for potential pregnancy due to sperm survival capability within the female reproductive tract and the timing relative to ovulation.

A brief episode of cramping and minor bleeding approximately 3 weeks after the last menstrual period could be due to implantation bleeding, occurring when a fertilized egg attaches to the lining of the uterus.