Maternal and Child Health Flashcards

A 28-year-old Saudi woman at 32 weeks gestation presents to the antenatal clinic with a blood pressure of 150/100 mmHg on two readings 4 hours apart, proteinuria of 2+ on dipstick, and complaints of epigastric pain. Her platelet count is 88,000/µL and AST is 112 U/L. According to SCFHS and Saudi MOH guidelines, which diagnosis best describes this clinical picture?

Answer: Severe preeclampsia with HELLP syndrome

This patient meets criteria for severe preeclampsia (BP ≥150/100 mmHg, proteinuria, epigastric pain indicating hepatic involvement) combined with HELLP syndrome features: thrombocytopenia (platelets 70 U/L). HELLP is a life-threatening variant of severe preeclampsia requiring urgent multidisciplinary management per Saudi MOH obstetric emergency protocols. Eclampsia requires seizure activity, which is absent here.

During a neonatal assessment in a Saudi hospital, a newborn at 38 weeks gestation is found to have a glucose level of 1.9 mmol/L at 2 hours of life. The baby is jittery but feeding poorly. The mother had gestational diabetes managed with insulin. According to Saudi MOH neonatal hypoglycemia protocols, what is the PRIORITY nursing intervention?

Answer: Administer IV dextrose 10% at 2 mL/kg as a bolus immediately

A symptomatic neonate (jitteriness, poor feeding) with blood glucose <2.0 mmol/L requires immediate IV dextrose 10% bolus at 2 mL/kg per Saudi MOH neonatal hypoglycemia guidelines. Symptomatic hypoglycemia is a medical emergency; oral feeding alone is insufficient and delays correction. Buccal dextrose gel is used for asymptomatic mild cases. Immediate IV correction followed by a continuous infusion is the standard of care when symptoms are present.

A nurse working in a Saudi primary healthcare center is conducting a well-child visit for a 15-month-old child. The mother reports the child has not yet started walking and uses only 2-3 words. According to the Saudi Child Health and Development Surveillance Program (Seha), which response is MOST appropriate?

Answer: Refer the child immediately to a developmental pediatrician for formal evaluation

At 15 months, a child is expected to walk independently (milestone: 12–15 months) and use at least 3 meaningful words. Failing both gross motor and language milestones simultaneously is a significant developmental red flag. Saudi MOH and the Seha Child Development Program mandate immediate referral when two or more developmental domains are delayed at any surveillance visit, rather than watchful waiting until the next scheduled review.

A postpartum Saudi woman on Day 3 after a cesarean section develops a fever of 38.6°C, uterine tenderness, and foul-smelling lochia. Her WBC is 18,000/µL. She is breastfeeding her neonate. The physician prescribes clindamycin and gentamicin IV for endometritis. What is the MOST important nursing consideration specific to this pharmacological regimen in the context of breastfeeding?

Answer: Both clindamycin and gentamicin are compatible with breastfeeding; continue breastfeeding and monitor the neonate for loose stools

Both clindamycin and gentamicin are classified as compatible with breastfeeding by international lactation pharmacology references (LactMed, WHO). Gentamicin has very low oral bioavailability, so negligible amounts are absorbed by the breastfeeding neonate even if present in breast milk. Clindamycin may cause loose stools in the infant, which should be monitored. Interrupting breastfeeding is not indicated and contradicts Saudi MOH breastfeeding promotion policies, which emphasize maintaining breastfeeding during most maternal antibiotic treatments.

A 24-year-old primigravida at 41+3 weeks gestation undergoes an oxytocin induction of labor in a Saudi tertiary hospital. The electronic fetal monitoring (EFM) shows a baseline FHR of 145 bpm, with repeated late decelerations after every contraction, and minimal variability (amplitude 2–5 bpm) over 40 minutes. The cervix is 5 cm dilated. The attending nurse should FIRST:

Answer: Place the mother in a left lateral position, discontinue oxytocin, administer O₂ via face mask at 8–10 L/min, and call the obstetrician immediately

Repeated late decelerations with minimal variability constitute a Category III (ominous) fetal heart rate pattern per ACOG/SCFHS intrapartum guidelines, indicating uteroplacental insufficiency and possible fetal acidemia. The priority nursing actions are: position change to lateral decubitus (improve uteroplacental blood flow), immediate oxytocin discontinuation (remove uterotonic stimulus), supplemental oxygen, IV fluid bolus, and urgent physician notification for possible emergency cesarean delivery. Amnioinfusion addresses variable decelerations (cord compression), not late decelerations.

A Saudi mother brings her 6-week-old male infant to the emergency department. She reports the baby has had forceful, non-bilious projectile vomiting after every feed for the past 5 days and now appears lethargic with dry mucous membranes. Blood gas shows pH 7.51, HCO₃ 34 mEq/L, pCO₂ 48 mmHg, and serum Cl⁻ 88 mEq/L. Which metabolic disturbance is present, and what is the underlying surgical condition?

Answer: Metabolic alkalosis with hypochloremia due to hypertrophic pyloric stenosis

The classic metabolic picture of hypertrophic pyloric stenosis (HPS) is hypochloremic, hypokalemic metabolic alkalosis caused by loss of HCl through repeated vomiting. The blood gas confirms metabolic alkalosis (pH 7.51, elevated HCO₃ 34 mEq/L) with respiratory compensation (elevated pCO₂). Low Cl⁻ (88 mEq/L, normal 98–106) confirms hypochloremia. HPS typically presents at 3–6 weeks in first-born males with projectile non-bilious vomiting. The Ramstedt pyloromyotomy is the definitive surgical treatment, after metabolic correction and fluid resuscitation.