G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST)

Complete the following sentence using the drop-down options.

The nurse's greatest concern is the client's risk of developing

__i_____

and related to

__ii____

and

___iii____

.

A. Assessment Cues

• Unprotected Sexual Activity increases the risk of sexually transmitted infections (STIs). The client has had multiple sexual partners in the past month without protection, making her susceptible to infections such as trichomoniasis, gonorrhea, chlamydia, and bacterial vaginosis. This is a significant risk factor for her symptoms.
• Foul-smelling discharge is a common symptom of trichomoniasis, bacterial vaginosis, and other vaginal infections. UTIs primarily cause dysuria, frequency, urgency, and suprapubic pain, not vaginal symptoms. Since the urinalysis does not show leukocytes, nitrates, or bacteria, a UTI is unlikely.

B. Condition – Trichomoniasis

The client's symptoms—green-yellow vaginal discharge, vaginal itching, and foul-smelling odor—are classic signs of trichomoniasis, a sexually transmitted infection caused by Trichomonas vaginalis. The disease is associated with malodorous discharge, vaginal irritation, and possible dysuria.

C. Anticipated Solutions

• Oral Metronidazole: The first-line treatment for trichomoniasis is oral metronidazole (Flagyl) 2g as a single dose or 500mg twice daily for 7 days. Metronidazole effectively eliminates the infection. Patients must be educated to avoid alcohol while taking metronidazole due to the risk of a disulfiram-like reaction (severe nausea and vomiting).
• Safe sexual behaviors, such as consistent condom use, regular STI screening, mutual monogamy, and open communication about sexual history, are essential for reducing the risk of sexually transmitted infections (STIs), including trichomoniasis.

Incorrect answers:

Human Papillomavirus (HPV): HPV causes genital warts and increases the risk of cervical cancer, but it does not typically cause vaginal discharge, itching, or foul odor. Therefore, HPV is not the most likely condition in this case.

Depression: While multiple sexual partners and STI diagnoses can cause emotional distress, depression is not directly relevant to her current presentation. However, mental health screening may be beneficial if she expresses concerns about her emotional well-being.

Herpes simplex virus (HSV) is a sexually transmitted infection (STI) that can cause genital ulcers, pain, and discomfort. However, based on the client’s symptoms, HSV is not the most likely diagnosis.

A. Retained placental fragments
This is incorrect because retained placental fragments are more commonly associated with prolonged third-stage labor or incomplete placental expulsion, rather than fetal macrosomia.

B. Uterine atony
This is correct because a large baby (macrosomia) causes overdistension of the uterus, increasing the risk of uterine atony (failure of the uterus to contract effectively). This can lead to postpartum hemorrhage.

C. Puerperal infection
This is incorrect because puerperal infection is usually related to prolonged rupture of membranes, poor hygiene, or invasive procedures, rather than fetal size alone.

D. Thrombophlebitis
While pregnancy increases the risk of clot formation, the most immediate concern for this client is uterine atony and postpartum hemorrhage.