A nurse is planning care for a client who is in labor and has gonorrhea. Which of the following actions should the nurse include in the plan for delivery?

Rationale for correct choices:

• Endoscopy: The client presents with a history of gnawing epigastric pain, one episode of dark, tarry stool, hypotension, tachycardia, and significant anemia. These findings suggest possible upper gastrointestinal bleeding or peptic ulcer disease. Endoscopy is the definitive diagnostic procedure to identify the source of bleeding and assess ulcer severity.
• Stool test results: The positive hemoccult (tarry stool) indicates gastrointestinal bleeding. This abnormal finding provides objective evidence that warrants further diagnostic evaluation through endoscopy to prevent further blood loss and complications.

Rationale for incorrect choices:

• Antibiotic prescription: While H. pylori infection can require antibiotics, this client’s immediate concern is gastrointestinal bleeding, not infection control. Antibiotics would not address the urgent need to identify and manage the bleeding source.
• Proton pump inhibitor therapy: Proton pump inhibitors help reduce gastric acid and promote ulcer healing, but initiating therapy alone does not evaluate or stop potential active bleeding. Endoscopy is needed first for diagnostic and possible therapeutic intervention.
• Hypotension: Although hypotension is present, it is a clinical sign of potential blood loss rather than a direct diagnostic criterion. It supports the urgency for endoscopy but is not the primary evidence for the procedure.
• Positive H. pylori test: While H. pylori infection contributes to ulcer formation, the acute presentation of bleeding evidenced by positive hemoccult stool makes the stool test a more immediate indicator for endoscopy.

A. Expected outcome of the procedure: The provider must explain the anticipated results of the colon resection so the client can make an informed decision about proceeding with the surgery.

B. Potential complications: The client should be informed of the risks and possible adverse events associated with the procedure, which is essential for informed consent.

C. Cost of the procedure: Financial information is not required for informed consent. While helpful for planning, it is not part of the medical disclosure required by the provider.

D. Explanation of the procedure: A clear description of the surgical steps allows the client to understand what the procedure entails, which is a fundamental component of informed consent.

E. Possible alternative treatments: The client must be aware of other treatment options, including the choice of no treatment, to make an informed decision regarding surgery.