A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

Peripartum cardiomyopathy is a form of heart failure that occurs during the last month of pregnancy or the first few months postpartum. Fluid restriction is often necessary to prevent fluid overload, which can exacerbate heart failure symptoms. By restricting fluid intake, the nurse helps manage the client's fluid balance and reduces the risk of worsening heart failure.

Choice B Reason:

Administering an IV bolus of fluids, such as lactated Ringer's, can increase the client's fluid volume, which is contraindicated in clients with heart failure, including peripartum cardiomyopathy. This could worsen the condition by increasing the workload on the already compromised heart.

Choice C Reason:

Assessing blood pressure is important in monitoring the client's cardiovascular status, but assessing it twice daily may not be sufficient for a client with peripartum cardiomyopathy, especially in the acute postpartum period. Blood pressure should be monitored more frequently, and any significant changes should be promptly addressed.

Choice D Reason:

Obtaining a prescription for misoprostol is incorrect. Misoprostol is a medication used for various purposes, including the prevention and treatment of postpartum hemorrhage. However, it is not a specific treatment for peripartum cardiomyopathy. The focus in peripartum cardiomyopathy management is on cardiac support and stabilization.

Explanation

Choice A Reason:

Absent Moro reflex is incorrect. The Moro reflex, also known as the startle reflex, is typically present in newborns and is characterized by the infant's arms extending and then flexing in response to a sudden movement or loud noise. While NAS can affect neurological function, causing irritability and hyperactivity, it typically does not result in the absence of the Moro reflex.

Choice B Reason:

Excessive crying is correct. Neonatal abstinence syndrome (NAS) occurs in newborns who were exposed to addictive opiate drugs while in the womb. Withdrawal symptoms can manifest in the neonate within the first few days after birth. Excessive crying is a common finding in infants with NAS. The crying may be inconsolable and difficult to soothe. This excessive crying is thought to be due to central nervous system irritability resulting from withdrawal.

Choice C Reason:

Diminished deep tendon reflexes are not typically associated with neonatal abstinence syndrome. Instead, NAS is more commonly characterized by hyperirritability of the central nervous system, leading to symptoms such as tremors, hypertonicity, and increased reflexes.

Choice D Reason:

Decreased muscle tone, or hypotonia, is not a typical finding in newborns with neonatal abstinence syndrome. Instead, infants with NAS may exhibit increased muscle tone (hypertonia) and jitteriness due to central nervous system hyperirritability.