The nurse is preparing the client for discharge.

Exhibits

Select the 3 client statements that indicate an understanding of the teaching.

Conditions:

1. Placental abruption, the premature separation of the placenta from the uterine wall, can occur due to hypertension, which increases the risk of vascular damage and bleeding behind the placenta, leading to its separation.
2. Oligohydramnios, a condition characterized by a deficiency of amniotic fluid, is typically associated with decreased fetal urine production, renal abnormalities, or placental insufficiency. However, none of the findings listed in the scenario directly correlate with this condition.
3. Spontaneous abortion, also known as miscarriage, can occur due to various factors such as genetic abnormalities, hormonal imbalances, or maternal health conditions. However, none of the findings listed in the scenario directly correlate with this condition.
4. Chorioamnionitis is an infection of the fetal membranes and amniotic fluid. While maternal fever is often associated with chorioamnionitis, it is not a finding listed in the scenario. Additionally, the other findings do not directly correlate with this condition.
5. Placenta previa is a condition where the placenta partially or completely covers the cervix. This condition is not directly associated with the findings listed in the scenario.

Findings:

1. Hypertension is a risk factor for placental abruption due to increased vascular resistance, which can lead to vascular damage and placental separation.
2. Temperature elevation may indicate an infection, such as chorioamnionitis, which can increase the risk of placental abruption.
3. Hyperreflexia can be associated with conditions like preeclampsia, which is characterized by hypertension and can increase the risk of placental abruption.
4. Vomiting alone is not directly associated with an increased risk of placental abruption.
5. Fundal height measurement can provide information about fetal growth and gestational age but is not directly associated with an increased risk of placental abruption.

Condition Most Likely Experiencing:

The client's admission to the behavioral health unit for prolonged weight loss and refusal to eat suggests a significant disordered eating pattern. The client's weight of 37.2 kg (82 lb) and BMI of 15 fall significantly below the healthy range for their height, indicating severe underweight status characteristic of anorexia nervosa. The client's behaviors during meal times, such as pushing food around the plate, eating only a small percentage of meals and snacks, and expressing anxiety about eating in front of others, are consistent with the restrictive eating patterns and fear of weight gain seen in anorexia nervosa.

Physical signs such as dry and flaky skin, dry and chapped lips, thin and dull hair, dry buccal mucosa, diminished bowel sounds, swollen and bloated abdomen, and lanugo (fine, downy hair) are commonly associated with anorexia nervosa due to malnutrition and starvation. The client's reported feelings of depression, initiation of dieting due to feeling fat compared to others, and cessation of menstrual cycles for the past 3 months are all indicative of the psychological and emotional distress often seen in individuals with anorexia nervosa.

Actions to take:

Clients with anorexia nervosa often benefit from a structured meal plan to promote regular eating habits and prevent skipping meals.

Focusing on the client’s underlying feelings of dysphoria and lack of control can help the client develop a more positive self-image and cope with emotional stressors that may trigger their eating disorder.

Parameters to monitor:

Monitoring weight is essential in assessing nutritional status and tracking changes in body composition, especially in clients with anorexia nervosa who may experience rapid weight loss.

Cardiac function with ECG can help the nurse detect any signs of cardiac arrhythmias, bradycardia, hypotension, or electrolyte imbalances that may result from severe malnutrition and dehydration.