The prenatal clinic nurse has received four phone calls. Which client should be called back first?
1. Multipara at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding
2. Multipara at 6 weeks with a seizure disorder inquiring what foods are good sources of folic acid
3. Primipara at 28 weeks with a history of asthma reporting difficulty breathing and shortness of breath
4. Primipara at 35 weeks with a positive hepatitis B surface antigen (HBsAG) wondering what treatment her baby will receive after birth
3
Explanation:
1. Pregnant women with untreated hyperthyroidism have an increased risk of fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. But the majority of spontaneous abortions prior to 12 weeks' gestation are complete and without complications. This client is not experiencing a normal pregnancy, but the health of both mother and fetus are not in immediate danger.
2. Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. This client is not the highest priority.
3. Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This client is the top priority.
4. A client with a positive HBsAG is contagious for hepatitis B. The risk of transmission to the fetus at birth is reduced by bathing the neonate as soon as possible after birth and giving the infant immunoprophylaxis and the first HBsAG vaccine dose. The client seeking information about what will happen after delivery is a low priority when there are pregnant clients currently experiencing physiologic problems.
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