A nurse at the family planning clinic triages several clients over the phone. Which of the following clients should the nurse instruct to come to the clinic?
A.
A client who uses a diaphragm for contraception and has lost 30 lb in the past 6 months dieting
B.
A client who had an intrauterine device (IUD) inserted yesterday and has cramping and bleeding
C.
A client who has started taking oral contraceptives and is experiencing bright red vaginal breakthrough bleeding
D.
A client who has sharp pain in her shoulder following a laparoscopic tubal ligation yesterday
The Correct answer and Explanation is:
The correct answer is D. A client who has sharp pain in her shoulder following a laparoscopic tubal ligation yesterday.
Explanation:
When triaging clients over the phone, it is essential for a nurse to identify symptoms that might indicate a serious or urgent condition. Each option in the scenario provides different clinical situations:
- Client with a diaphragm and recent weight loss (Option A):
- The diaphragm is a barrier method of contraception, and significant weight loss can affect its fit. However, this situation does not typically require urgent evaluation unless the client is experiencing related complications such as discomfort or ineffective contraception. For weight loss affecting the fit of the diaphragm, a follow-up appointment for reassessment might be appropriate, but it is not urgent.
- Client with cramping and bleeding after IUD insertion (Option B):
- Cramping and bleeding are common side effects following IUD insertion. This typically resolves within a few days to a week as the uterus adjusts to the device. While the client should be monitored and possibly seen if symptoms persist or worsen, cramping and bleeding in the immediate post-insertion period are usually expected and not urgent unless there are severe symptoms or signs of infection.
- Client with bright red vaginal breakthrough bleeding on oral contraceptives (Option C):
- Breakthrough bleeding can occur with the initiation of oral contraceptives, especially in the first few months as the body adjusts to the hormonal changes. This is generally not an urgent situation unless accompanied by severe symptoms or persistent issues beyond the initial adjustment period. A follow-up visit can be scheduled if the bleeding continues or becomes problematic.
- Client with sharp shoulder pain following laparoscopic tubal ligation (Option D):
- Sharp shoulder pain following laparoscopic tubal ligation is concerning for referred pain due to diaphragmatic irritation from residual carbon dioxide used during the procedure. This type of pain could indicate complications such as pneumoperitoneum (presence of gas in the abdominal cavity) or other post-operative issues. It requires prompt evaluation to rule out serious complications and ensure appropriate management.
In summary, Option D is the most urgent as sharp shoulder pain following a laparoscopic procedure could be indicative of a more serious complication that warrants immediate attention. The nurse should instruct this client to come to the clinic for evaluation to ensure there are no complications and to provide appropriate care.