A nurse performs the assessment of a patient posted for caesarean section delivery. Which assessment would indicate the need to contact the doctor?

Appeared in: BCCL kharkhanda Staff Nurse - 2015

Explanation

The normal fetal heart rate (FHR) is between 110 and 160 beats per minute (bpm).
An FHR of 180 bpm is classified as fetal tachycardia, which is an abnormal finding.
Fetal tachycardia can be a sign of fetal distress due to conditions like hypoxia, maternal fever, or infection.
This finding is the most critical among the options and warrants immediate notification of the doctor for prompt evaluation and management.

Option A: A haemoglobin level of 11 gm/dL is at the lower limit of the normal range (11-14 gm/dL) for a pregnant woman. While it indicates borderline anemia, it is a common finding and does not represent an acute emergency requiring immediate doctor notification before a planned C-section.
Option C: A maternal pulse of 84 beats per minute is well within the normal range of 60-100 beats per minute for an adult at rest.
Option D: A white blood cell count of 12,000/mm³ is within the expected range for a pregnant patient. Pregnancy normally causes a slight elevation in WBCs (physiological leukocytosis), with the upper limit of normal being around 15,000/mm³.

Clinical Relevance

Nursing practice connection: Use the key finding related to Interpretation of maternal and fetal assessment data in a preoperative patient to guide bedside assessment, documentation, and the next nursing action.
Recognizing deviations in fetal heart rate is a critical nursing skill in obstetrics. Prompt identification and reporting of tachycardia or bradycardia can prevent adverse fetal outcomes like hypoxic brain injury or death.
A nurse's role includes not just data collection but also interpretation. Understanding which values are normal physiological changes of pregnancy versus which are red flags is essential for patient safety.
What if? If the fetal heart rate was 100 beats/min, this would be fetal bradycardia (FHR less than 110 bpm), which is also a critical finding indicating potential fetal distress (e.g., from cord compression or placental insufficiency) and would similarly require immediate notification of the doctor.

How to Approach the Question

First, identify the core of the question: which finding is the most urgent or dangerous?
Recall the normal physiological parameters for a pregnant woman and a fetus. This includes normal ranges for maternal vital signs, blood counts, and fetal heart rate.
Systematically evaluate each option by comparing the given value to its normal range.
Option A (Hb 11): Borderline normal. Not an emergency.
Option B (FHR 180): Abnormal (tachycardia). A sign of potential fetal distress. This is a high-priority concern.
Option C (Maternal Pulse 84): Normal.

Concept Tested & Keywords

Concept Tested: Interpretation of maternal and fetal assessment data in a preoperative patient.
Stem keywords: caesarean section, assessment, contact the doctor
Lead-in keywords: Which assessment
Clinical cues: Patient posted for caesarean section

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Practise the full BCCL kharkhanda Staff Nurse - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.