A nurse is collecting data during an admission assessment of a client who is pregnant with twins.

The client has a healthy 5-year-old child that was delivered at 38 weeks, and tells the nurse that she does not have any history of abortion or fetal demise.

The nurse would document the GTPAL for this client as:

Choice A rationale

An increase in baseline variability is generally considered a reassuring sign of fetal well-being, indicating a responsive central nervous system and adequate oxygenation. While important to monitor, it is not a specific periodic pattern to observe immediately following membrane rupture due to potential cord compression. Normal baseline variability ranges from 6 to 25 beats per minute.

Choice B rationale

Non-periodic accelerations are abrupt increases in fetal heart rate above the baseline, typically lasting less than 30 seconds. They are usually a reassuring sign, often occurring with fetal movement or stimulation. While their presence is noted, they are not the primary periodic pattern to observe immediately after membrane rupture for potential complications.

Choice C rationale

Early decelerations are gradual decreases in fetal heart rate that mirror the uterine contractions. They are thought to be caused by fetal head compression and are generally considered benign. While their presence is documented, they are not the most concerning pattern immediately after membrane rupture, which raises the risk of cord issues.

Choice D rationale

Variable decelerations are abrupt decreases in fetal heart rate that are variable in timing and shape in relation to uterine contractions. They are often caused by umbilical cord compression, which is a significant risk factor immediately following the rupture of membranes, as the fluid cushion around the cord is reduced. Prompt identification is crucial for intervention.

Choice A rationale

Postpartum blues are characterized by labile mood, tearfulness, anxiety, and irritability that typically peak around the third to fifth postpartum day and resolve within two weeks. These feelings are often attributed to hormonal shifts, psychological adjustments, and fatigue experienced after childbirth. The woman's statement of feeling "let down" and crying for no reason, occurring on the fourth postpartum day, aligns with the typical presentation of postpartum blues.

Choice B rationale

Postpartum depression (PPD) involves more intense and persistent symptoms than postpartum blues, including depressed mood, loss of interest or pleasure, changes in appetite and sleep, fatigue, feelings of worthlessness or guilt, and difficulty concentrating. These symptoms typically last longer than two weeks and interfere with daily functioning. The woman's statement alone does not provide enough information to diagnose PPD.

Choice C rationale

Postpartum delirium is a rare but serious psychiatric emergency characterized by rapid onset of confusion, disorientation, hallucinations, delusions, and agitation. It typically occurs within the first few days postpartum. The woman's description of her feelings does not suggest the presence of delirium.

Choice D rationale

Attachment difficulty refers to challenges in forming a secure emotional bond between the mother and her infant. While the woman expresses loving her son, her emotional state of feeling "let down" and crying is not a direct indicator of attachment difficulties, which manifest as a lack of engagement or negative interactions with the baby.