A client at 10 weeks gestation provides the following obstetric history to the nurse at the first prenatal visit: elective abortion at age 17, a 5-year-old daughter born at 40 weeks gestation, and 3-year-old twin boys born at 34 weeks gestation.
Using GTPAL notation, which documentation appropriately describes the client's obstetric history?

The condition that poses the greatest risk to the newborn is meconium aspiration syndrome due to amniotic fluid.

Rationale for correct answers

Meconium aspiration syndrome (MAS) occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction, chemical pneumonitis, and surfactant dysfunction. The presence of dark brown-greenish amniotic fluid, along with mild respiratory distress (nasal flaring, increased respiratory rate of 60/min), raises concern for MAS. Close monitoring for worsening respiratory symptoms is essential.

Amniotic fluid contamination with meconium increases the risk of lung inflammation and infection. The newborn’s vigorous condition suggests mild aspiration, but continuous observation is needed.

Rationale for incorrect Response 1 options

• Jaundice: While term newborns may develop physiological jaundice, there are no indications of hyperbilirubinemia or hemolysis in this case.
• Hypoglycemia: No jitteriness or poor feeding, and birth weight is within normal range; hypoglycemia more commonly affects preterm or low birth weight infants.
• Cold stress: The newborn is under a radiant warmer, and temperature is within normal range (36.5°C).

Rationale for incorrect Response 2 options

• Birth weight: No signs of growth restriction or macrosomia-associated complications.
• Acrocyanosis: Normal in newborns due to immature circulation, not an indicator of respiratory compromise.
• Apgar scores: Strong Apgar scores (8 and 9) suggest good adaptation to extrauterine life.

Choice A rationale

Pounding headache, visual changes, and epigastric pain in a patient with pregnancy-induced hypertension (PIH), now known as gestational hypertension or preeclampsia, are classic signs of worsening disease and indicate central nervous system irritability and potential hepatic involvement. These symptoms suggest the condition is progressing towards severe preeclampsia and increase the risk of eclampsia, which is characterized by seizures.

Choice B rationale

Magnesium sulfate is used to prevent seizures in severe preeclampsia. While it can cause side effects such as flushing, warmth, and muscle weakness, it does not typically cause pounding headache, visual changes, or epigastric pain. These symptoms are more indicative of the underlying disease process rather than the treatment.

Choice C rationale

Anxiety due to hospitalization can cause various symptoms, but the specific combination of pounding headache, visual changes, and epigastric pain is more strongly associated with the physiological changes occurring in worsening preeclampsia rather than solely psychological distress.

Choice D rationale

Gastrointestinal upset can cause epigastric pain, but it would not typically be accompanied by pounding headache and visual changes in the context of pregnancy-induced hypertension. The constellation of these symptoms strongly points towards a worsening of the hypertensive condition and potential end-organ involvement. .