When assessing a client who is at 18 weeks of gestation, there are several key findings to consider. Let's examine each of these findings one by one:
1. Deep tendon reflexes 4+:
- Deep tendon reflexes are typically assessed to monitor the client's neurological status. The grading scale goes from 0 (no response) to 4+ (hyperactive with clonus).
- For pregnant clients, deep tendon reflexes should typically be within the range of 1+ to 2+. A reflex score of 4+ is considered abnormal and may indicate hyperreflexia, which could be a sign of preeclampsia or other neurological concerns.
2. Fundal height 14 cm:
- Fundal height is the distance from the pubic bone to the top of the uterus and is typically measured in centimeters. It helps estimate the gestational age and the growth of the fetus.
- At 18 weeks of gestation, the expected fundal height is approximately 18 cm (give or take 2 cm). A fundal height of 14 cm is below the expected range and is considered abnormal for 18 weeks. This discrepancy may suggest that the fetus is not growing as expected or other complications.
3. Blood pressure 142/94 mm Hg:
- Blood pressure is another vital parameter that needs monitoring during pregnancy.
- Normal blood pressure during pregnancy should generally be below 140/90 mm Hg. A reading of 142/94 mm Hg is elevated and may be a sign of hypertension, including gestational hypertension or preeclampsia, which are conditions requiring prompt medical attention.
4. FHR 152/min:
- Fetal Heart Rate (FHR) is an important indicator of the fetus's well-being.
- The normal range for FHR is between 110 to 160 beats per minute. A FHR of 152/min falls within the normal range, indicating that the fetal heart rate is as expected for this stage of pregnancy.
In summary, the nurse should expect the following findings during the assessment of a client at 18 weeks of gestation:
- Deep tendon reflexes: 4+ (abnormal)
- Fundal height: 14 cm (abnormal)
- Blood pressure: 142/94 mm Hg (elevated)
- FHR: 152/min (normal)
These findings indicate that while the fetal heart rate is within the expected range, the other parameters—deep tendon reflexes, fundal height, and blood pressure—are not within normal limits and may warrant further investigation and possibly medical intervention.
