A nurse assisting with the care of a client who is admitted to the medical-surgical unit.

The nurse is reviewing the client's laboratory findings and vital signs.

Select the 5 findings that require immediate follow-up.

A) Rigid abdomen: A rigid abdomen is more commonly associated with conditions like placental abruption or uterine rupture, where there is significant internal bleeding and trauma to the uterine wall. It is not a typical finding in placenta previa, where bleeding is typically present without uterine rigidity.

B) Bright red vaginal bleeding: Bright red vaginal bleeding is the most characteristic finding in placenta previa. The condition occurs when the placenta is abnormally located in the lower part of the uterus, covering or being near the cervix. This leads to painless, bright red vaginal bleeding, which is often seen in the second or third trimester. The bleeding results from the placenta's location as the uterus expands.

C) Persistent uterine contractions: Persistent uterine contractions are more often associated with preterm labor or placental abruption, not placenta previa. While contractions can occur in placenta previa, they are not the primary or most expected symptom. The hallmark of placenta previa is bleeding, rather than contractions.

D) Increased fetal movement: Fetal movement is not typically altered by placenta previa. In some cases, the location of the placenta may affect the feeling of fetal movement, especially if the placenta is anterior, but increased fetal movement is not a specific finding associated with placenta previa. The focus should be on bleeding and uterine stability.

The client reports joint pain in the knee and wrist with a history of gout in the family. The elevated uric acid level (7.2 mg/dL) supports a diagnosis of gout, a condition caused by uric acid crystal deposition in the joints. The negative ANA and normal ESR make inflammatory autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus unlikely.

Actions to Take:

Instruct the client to avoid foods high in purines.

Purine-rich foods (e.g., red meat, shellfish, organ meats) contribute to increased uric acid production, exacerbating gout symptoms. Dietary modifications can help reduce flare-ups and long-term complications.

Instruct the client to apply topical analgesics.

Topical analgesics can provide localized pain relief and reduce discomfort in affected joints. They serve as an adjunct to systemic medications in managing acute symptoms.

Parameters to Monitor:

Uric acid levels.

Monitoring uric acid levels helps assess the effectiveness of dietary changes and medications in preventing flare-ups and reducing joint damage.

Joint deformities.

Chronic gout can lead to joint destruction and tophi formation, so assessing for deformities helps track disease progression and the need for further interventions.