Passage / Scenario

A nurse is caring for a client at the next prenatal visit. Vital Signs:
Initial visit, 1330:
ÔÇó Heart rate 110/min
ÔÇó Respiratory rate 18/min
ÔÇó Blood pressure 104/66 mm Hg
ÔÇó Temperature 36.6┬░ C (97.9┬░ F)
ÔÇó Oxygen saturation 99% on room air
9-week visit, 0955:
ÔÇó Heart rate 116/min
ÔÇó Respiratory rate 20/min
ÔÇó Blood pressure 92/50 mm Hg
ÔÇó Temperature 36.5┬░ C (97.7┬░ F)
ÔÇó Oxygen saturation 97% on room air
Nurses' Notes
29-year-old gravida 2, para 0 client presents with report of a positive home pregnancy test from 2 weeks ago. Last menstrual period was 7 weeks ago. Urine human chorionic gonadotropin (hCG) test positive. Client reports vomiting several times a day over the last 2 weeks and states, "I'm a vegetarian and I don't usually eat a lot of protein, but it's still hard to keep anything down." Decreased skin turgor noted, oral mucous membranes moist. Weight 79.4 kg (175 lb).
9-week visit, 1000:
Client returned to clinic for follow-up visit after initial prenatal appointment 2 weeks ago. Client reports continued nausea and recurrent episodes of vomiting every day. Has been unable to complete work or sleep well at night due to nausea and vomiting.
Poor skin turgor with tenting noted. Oral mucous membranes dry. Urine reagent strip results of large amount of ketones. Client tearful, reassurance provided. Weight today is 77.6 kg
Laboratory Results
ÔÇó WBC count 7,500/mm3 (5,000 to 10,000/miny Hgb 10.2 g/dL (11 to 16 g/dL)
ÔÇó Hct 45% (33% to 47%)
ÔÇó Platelets 360,000/mm3 (150,000 to 400,000/mm3)
ÔÇó Sodium 136 mEq/L (136 to 145 mEq/L)
ÔÇó Potassium 3.3 mEq/L (3.5 to 5 mEq/L)
ÔÇó BUN 28 mg/dL (10 to 20 mg/dL)
Urinalysis:
ÔÇó Appearance clear (clear)
ÔÇó Color dark amber yellow (pale yellow amber)
ÔÇó pH 7.9 (4.6 to 8)
ÔÇó Protein 4 mg/dL (0 to 8 mg/dL)
ÔÇó Specific gravity 1.045 (1.005 to 1.03)
ÔÇó Leukocyte esterase negative (negative)
ÔÇó Nitrites none (none)
ÔÇó Ketones large (none)
ÔÇó Bilirubin none (none)
ÔÇó Glucose none (none)
History and Physical
9-week visit, 1030:
Client is primigravida at 9 weeks of gestation. No significant medical or surgical history. Now reports continued vomiting, has lost 1.8 kg (4 lb) since prior visit. Mucous membranes dry, poor skin turgor, and ketonuria noted. FHR 156/min via Doppler ultrasound. Recommended admission to antepartum unit for treatment of hyperemesis gravidarum.