A nurse at a provider's office is caring for a client who is 28 years of age.
The nurse is preparing the client for surgery. Which of the following actions should the nurse take?
Select all that apply.
History and Physical
Day 1 at 1000:
Gravida 3, Para 2, Abortion 1
Asthma (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.
Day 1 at 1100:
Client was given information about ectopic pregnancy. Client to notify provider or go to the emergency room if excessive bleeding, severe sharp abdominal pain, lightheadedness, or dizziness occur. Client to return to office in 2 days for repeat quantitative β-hCG.
Vital Signs
Day 1 at 1000:
Temperature 37.2° C (98.9° F), Heart rate 90/min, Respirations 16/min, Blood pressure 120/74 mm Hg, Oxygen saturation 97% room air
Day 1 at 1030:
Temperature 37.2° C (98.9° F), Heart rate 104/min, Respirations 18/min, Blood pressure 116/70 mm Hg, Oxygen saturation 97% room air
Diagnostic Results
Day 1 at 1015:
Urine human chorionic gonadotropin (HCG) positive (negative)
Day 1 at 1030:
Blood human chorionic gonadotropin (hCG) 50 IU/L (less than 5 IU/L)
Quantitative beta human chorionic gonadotropin (β-hCG) 20,000 IU/L (negative)
Progesterone 4 ng/dL (1st trimester 725 to 4400 ng/dL)
Hgb 11 g/dL (12 to 16 g/dL)
Hct 35% (37 to 47%)
Platelets 152,000/mm3 (150,000 to 300,000/mm3)
Day 3 at 0830:
Transvaginal ultrasound: No intrauterine pregnancy.
Pelvic ultrasound: Right Fallopian tube- ampulla contains products of conception.
Quantitative β-hCG 15,000 IU/L (negative)
Blood type B negative
Provider Prescriptions
Day 1 at 1100:
Transvaginal ultrasound (outpatient radiology clinic).
Repeat quantitative β-hCG in 2 days.
Blood typing in 2 days.
Take acetaminophen 1 to 2 tablets every 6 hr PRN pain.
Day 3 at 0900:
Schedule client for laparoscopic right salpingostomy within 24 hr.
A. Ensure the client is NPO prior to surgery.
B. Administer Rho D immune globulin prior to surgery.
C. Prepare to administer AB positive blood products if needed.
D. Insert an 18-gauge peripheral IV prior to surgery.
E. Explain the surgical procedure to the client.
F. Obtain a complete blood count.
G. Verify a consent form is signed by the client.