Exhibits

The nurse is reviewing nurses' notes to determine what the client's obstetric history reveals in the form of GTPAL.

Choose the most likely option for the information missing from the statement by selecting from the list of options provided.
Based on the client's obstetrical history, the client's G-T-P-A-L designation is____________.

A. Electrolytes: Electrolytes are important to monitor in this client due to potential blood loss and altered kidney function. Electrolyte imbalances (especially sodium and potassium) can affect heart function, muscle strength, and overall fluid balance, which is crucial after trauma and surgery.

B. Coagulation studies: Given the trauma (liver and spleen lacerations), the client is at risk for bleeding. Coagulation studies (including PT, INR, and aPTT) are necessary to assess the clotting ability and manage bleeding risk, particularly before surgery or when planning for interventions.

C. Blood culture: While blood cultures are important for identifying infections, there is no immediate indication of infection in this patient at this point in time. The priority is stabilizing the patient and managing trauma and bleeding.

D. Lipid panel: A lipid panel is not a priority at this moment. It is generally used to assess cardiovascular risk and would not provide immediate information relevant to managing acute trauma and bleeding.

E. Complete blood count (CBC): A CBC is essential to assess for anemia, infection, or other hematologic abnormalities, especially in trauma patients with possible internal bleeding. Hemoglobin and hematocrit levels provide information about blood loss and oxygen-carrying capacity.

F. Urine osmolality: Urine osmolality is useful for assessing kidney function and hydration but is not immediately necessary in this trauma case. The priority is stabilizing the patient's circulatory and respiratory status, with more focus on urine output and renal function.

G. Arterial blood gas (ABG): An ABG is crucial to assess the client’s oxygenation, ventilation, and acid-base status, especially since the client is intubated and on a ventilator. This will help in monitoring respiratory function and ensuring proper oxygen delivery.

H. Type and screen: The client has a history of trauma and potential internal bleeding. It is essential to know her blood type and ensure compatibility for any potential blood transfusions, particularly before the exploratory laparotomy and any possible further blood loss.

Rationale:

• Convert the client's weight from pounds (lb) to kilograms (kg).

Weight in kg = 132 lb / 2.2 lb/kg

= 60 kg.

• Calculate the desired dose per minute in micrograms (mcg).

Desired dose per minute (mcg/min) = Desired dose (mcg/kg/min) × Weight (kg)

= 5 mcg/kg/min × 60 kg

= 300 mcg/min.

• Convert the desired dose from micrograms per minute (mcg/min) to milligrams per hour (mg/hr).

1 mg = 1000 mcg

1 hr = 60 min

Desired dose in mg/hr = (300 mcg/min / 1000 mcg/mg) × 60 min/hr

= 0.3 mg/min × 60 min/hr

= 18 mg/hr.

• Determine the concentration of the available Dopamine solution in milligrams per milliliter (mg/mL).

Available concentration = Total medication (mg) / Total volume (mL)

= 1600 mg / 500 mL

= 3.2 mg/mL.

• Calculate the IV pump rate in milliliters per hour (mL/hr).

IV pump rate (mL/hr) = Desired dose (mg/hr) / Available concentration (mg/mL)

= 18 mg/hr / 3.2 mg/mL

= 5.625 mL/hr.

• Round the answer to the nearest tenth.

= 5.6