A 22-year-old single patient, G1, P0, accompanied by her boyfriend, is admitted to the labor unit with ruptured membranes and mild to moderate contractions. She is determined to be 2 centimeters dilated
Which nursing diagnoses might apply during the current stage of labor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fear/Anxiety related to discomfort of labor and unknown labor outcome
2. Deficient Knowledge related to lack of information about involution process
3. Acute Pain related to uterine contractions, cervical dilatation, and fetal descent
4. Acute Pain related to perineal trauma
5. Compromised Family Coping related to labor process
1,3,5
Rationale 1: This diagnosis would apply to the first stage of labor for a first-time labor patient.
Rationale 2: This diagnosis would apply during the fourth stage of labor.
Rationale 3: Contractions become more regular in frequency and duration, increasing discomfort and pain.
Rationale 4: This diagnosis would apply during the third and fourth stages.
Rationale 5: The patient and family might experience increased anxiety and fear related to lack of knowledge.
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A patient has been complaining of headaches. If the headaches are migraine, the nurse would expect to assess that the headaches:
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a. 3 mL b. 5 mL c. 10 mL d. 15 mL
Microscopic hematuria is defined as
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