A nurse is caring for a client who is at 36 weeks of gestation.

Exhibits

For each day 2 finding, click to specify whether the finding indicates that the client's condition has improved, has not changed, or has declined.

Rationale:

A. A heart rate of 130/min is elevated and may indicate continued dehydration or stress. It does not necessarily indicate the effectiveness of oral rehydration therapy.

B. A capillary refill greater than 3 seconds indicates poor perfusion and ongoing dehydration. It does not indicate the effectiveness of oral rehydration therapy.

C. A respiratory rate of 24/min is within normal range for a 3-year-old child. It does not necessarily indicate the effectiveness of oral rehydration therapy.

D. A urine specific gravity of 1.015 indicates adequate hydration. Normal urine specific gravity typically ranges from 1.005 to 1.030, and a value closer to 1.015 indicates proper hydration

status. Therefore, this finding suggests that oral rehydration therapy has been effective in restoring fluid balance.

Rationale:

A. Preterm delivery: While preterm delivery can result in low birth weight, it is not typically considered a direct cause of being small for gestational age (SGA). SGA infants are generally small because of intrauterine growth restriction rather than preterm birth.

B. Fetal hyperinsulinemia: Fetal hyperinsulinemia may lead to macrosomia (large for gestational age) rather than SG

A.

C. Perinatal asphyxia: Perinatal asphyxia refers to oxygen deprivation around the time of birth and is not typically associated with SG

A.

D. Placental insufficiency: Placental insufficiency, resulting in poor nutrient and oxygen transfer to the fetus, is a common cause of SG

A. Insufficient placental function can limit fetal growth,

leading to a newborn being small for their gestational age.