Assignment Case Scenario:
Read the instructions and questions in the case study below. All answers should be complete, include rationale, and have a citation. This assignment is graded by rubric in the Syllabus and Important Documents.
Scenario:
Problem 1: D.H. Is a 34 year old multigravida patient who wants to use the Basal Body Temperature method of the Fertility Awareness methods of birth control because she is "becoming older" and wants a less invasive method of birth control. D.H. desires more information about Basal Body Temperature method of birth control. Explain BBT method of birth control to include indications, reliability, risks, benefits, and how to use this method.
Problem 2: D.H. at 37 years old comes to the clinic stating, "I think I may be pregnant. I haven't had a period in 10 weeks, my breasts are tingling, and I don't fit into my jeans." Based upon this information, what type of Signs of Pregnancy is this client experiencing?
Problem 3: This is her fifth pregnancy. She has two children 8 and 3 at home both term deliveries (still living). Other pregnancies were spontaneous abortions. What is the GP and GTPAL based upon her maternal history?
Problem 4: An ultrasound is done at the initial visit and confirms that the client is 7 weeks pregnant. What type of ultrasound was performed (using the number of weeks as a guide to determine the appropriate type)?
a. What instructions would have been given to the client prior to the ultrasound being performed?
Problem 5: The client states that her last period began on 2 March. Using Naegel's rule, what is the expected date of delivery?
Problem 6: D.H. has an uneventful perinatal history. Then, at her 38 week prenatal appointment the nurse assesses the following: weight 176 lbs (increase of 10 lbs in one week); swelling in her hands, feet, and face; edema +2; blood pressure of 142/94 mmHg; pulse 88 bpm; edema +2; deep tendon reflexes +2; no clonus; proteinuria +2 (on urine dip); negative urine glucose; frontal headache with eases with acetaminophen. She states the light is too bright while shielding her eyes. What other questions should a nurse ask the patient at this time?
Problem 7: What laboratory values should be considered at this time?
Problem 8: What are the risk factors for preeclampsia (all of them)? Identify the risk factors that this patient has for preeclampsia?
Problem 9: What are three possible complications with preeclampsia?
Problem 10: Write the priority physiologic nursing diagnosis for this client (what is the most important safety need)? Write a goal for this diagnosis.
Priority Questions:
Problem 1: A 19-year-old gravida 1, para 0 patient at 40 weeks' gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments with this medication? Select all that apply.
a. Check deep tendon reflexes.
b. Observe for vaginal bleeding.
c. Check the respiratory rate.
d. Note the urine output.
e. Monitor for calf pain.
Problem 2: A 30-year-old woman with type 1 diabetes mellitus comes to the clinic for preconception care. What is the priority education for her at this time?
a. Her insulin requirements will likely increase during the second and third trimesters of pregnancy.
b. Infants of mothers with diabetes can be macrocosmic, which can result in more difficult delivery and higher likelihood of cesarean section.
c. Breast feeding is highly recommended, and insulin use is not a contraindication.
d. Achievement of optimal glycemic control at this time is of utmost importance in preventing congenital anomalies.
Problem 3: The telephone triage nurse in the prenatal clinic receives the following calls. Which telephone call would require immediate notification of the health care provider?
a) Patient reports leaking vaginal fluid at 34 weeks' gestation.
b) Patient reports nausea and vomiting at 8 weeks' gestation.
c) Patient reports pedal edema at 39 weeks' gestation.
d) Patient reports vaginal itching at 20 weeks' gestation.
Problem 4: A pregnant woman at 12 weeks' gestation tells the nurse that she is a vegetarian. What would be the first appropriate nursing action?
a. Recommend vitamin B12 and iron supplementation.
b. Recommend consumption of protein drinks daily.
c. Obtain a 24-hour diet recall history.
d. Determine the reason for her vegetarian diet.
Problem 5: A 23-year-old gravida 1, para 0 patient at 10 weeks' gestation states that she exercises 5 days a week. The nurse has discussed exercise in pregnancy with her. Which statement by the patient indicates that more teaching of evidence-based principles is needed?
a) . "I will continue to exercise 5 days a week."
b) "I will reduce my exercise at this time in my pregnancy to reduce the risk of miscarriage but will increase it in the second trimester."
c) "I will drink more fluid before and after exercising."
d) "I will stop playing football while I am pregnant."
Problem 6: A 30-year-old gravida 6, para 5 woman at 12 weeks' gestation has just begun prenatal care, and her initial laboratory work reveals that she has tested positive for human immunodeficiency virus (HIV) infection. What would be priority evidence-based nursing edu- cation for this patient today?
a. Medication for HIV infection is safe and can greatly reduce transmission of HIV to the infant.
b. Breast feeding is still recommended due to the great benefits to the infant.
c. Pregnancy is known to accelerate the course of HIV disease in the mother.
d. Cesarean section is not recommended because of the increased risk of HIV transmission with the bleeding at surgery.
Problem 7: A female same-sex couple is being seen in the clinic today. They inform the nurse that they are planning a pregnancy and plan to use donor sperm to be inseminated into one of the women. What is the priority education at this time?
a. Refer the couple to another health center specializing in same-sex issues and explain that you do not have the expertise to deal with their issues.
b. Review all preconception education issues, including vaccines, diet, folic acid use, avoidance of alcohol and medications, and the importance of physical and mental health prior to pregnancy.
c. Ask the couple if they have considered the effects on a child of having same-sex parents.
d. Inform them that donor sperm carry an increased risk of infection and chromosomal disorders.
Problem 8: The health care provider has ordered a flu vaccine for a patient in the prenatal clinic. As the nurse prepares to give it, the patient states she does not want the vaccine as she never gets it and never had the flu. How can the nurse best respond to the patient?
a) Respect the patient's preference and offer education on how to avoid getting the flu by good hand washing, good nutrition, and adequate rest.
b) Inform the patient that changes in the heart, lungs, and immune system in pregnancy puts her in a higher risk group for complications of flu and that the flu in pregnancy is also associated with pregnancy complications such as premature delivery.
c) Inform the patient that it is acceptable to defer the vaccine until the postpartum period if she is worried about vaccine's effects in pregnancy.
d) Explain that the vaccine is mandatory in pregnancy
Problem 9: The patient is 32 weeks pregnant with a diagnosis of complete placenta previa and is experiencing heavy vaginal bleeding. The plan of care is immediate blood transfusion and emergency cesarean section. The patient tells the nurse that she does not want the blood transfusion because she is concerned about getting hepatitis from it. Her husband shares this concern, and the couple is declining the transfusion. How should the nurse proceed?
a) Allow the patient to decline the blood transfusion, move her quickly to the operating room to prepare for emergent cesarean section, and inform the obstetrician that the patient has declined.
b) Quickly inform the patient that the blood transfusion is mandatory because of the amount of bleeding she is experiencing. State that there is virtually no risk of bloodborne infection.
c) Speak quickly and intently to the couple while moving to the operating room. Collaborate with the obstetrician to quickly counsel the couple about the risk-to-benefit ratio she is facing.
d) Call the blood bank and request that they come to the bedside and outline the risks and benefits of blood transfusion in this case before the surgery is allowed to start.
Problem 10: A 30-year-old gravida 6, para 5 woman at 12 weeks' gestation has just begun prenatal care, and her initial laboratory work reveals that she has tested positive for human immunodeficiency virus (HIV) infection. What would be priority evidence-based nursing edu- cation for this patient today?
a) Medication for HIV infection is safe and can greatly reduce transmission of HIV to the infant.
b) Breast feeding is still recommended due to the great benefits to the infant.
c) Pregnancy is known to accelerate the course of HIV disease in the mother.
d) Cesarean section is not recommended because of the increased risk of HIV transmission with the bleeding at surgery.
Ms. N is a 20-year-old gravida 1, para 0 (G1P0) woman who begins her prenatal care today at 24 weeks' gestation. She says that she didn't know she was pregnant until now. Her prepregnancy body mass index was 23. She has gained 30 lb (13.6 kg) so far. She admits that she eats poorly and smokes a half-pack of cigarettes daily but claims to use no other substances. She lives with her boyfriend and has no immediate family in the area. She reports no significant medical, surgical, or family history. The RN is taking her history and drawing samples for laboratory work today on this first prenatal visit.
Problem 11: What would be the priority topics in client teaching today? Select all that apply.
a) Smoking cessation methods
b) Recommendation of a flu shot (if flu season)
c) Danger signs during pregnancy
d) Basics of nutrition 5. Pain relief options in labor and birth
Ms. N returns for her second prenatal appointment 1 week later. Her laboratory results include the following abnormal findings: 1-hour glucose tolerance test, 190 mg/dL (10.5 mmol/L); Pap smear results, low-grade squamous intraepithelial lesion with high-risk human papillomavirus (HPV) present; and chlamydia test, positive for the organ- ism. The health care provider (HCP) has written orders for a 3-hour glucose tolerance test and a colposcopy, and has pro- vided a prescription for azithromycin 1 g by mouth. Ms. N has increased her smoking to 1 pack/day because of stress.
Problem 12: What would be accurate and priority information to give Ms. N about the positive chlamydia test result?
a) By taking the medication now and having her partner treated, she can help avoid complications in the pregnancy.
b) The medication for chlamydia infection is not safe in pregnancy, and she should use condoms until she can be treated postpartum.
c) Chlamydia infection cannot really be cured and may recur despite treatment.
d) Chlamydia infection does no harm to the baby during the pregnancy or at delivery, but treatment is recommended to avoid pelvic inflammatory disease in the woman.
Problem 13: What else would be priority education given the scenario described earlier?
a. Instruct Ms. N not too fast for the 3-hour glucose tolerance test because it is not safe to do so in pregnancy.
b. Refer Ms. N to a social worker because her increased stress can be a risk factor for preterm birth.
c. Instruct Ms. N that genital HPV infection can be effectively treated with colposcopy.
d. Instruct Ms. N that, if HPV is present at the time of labor, a cesarean section will be needed.
Later that evening Ms. N calls the clinic and reports vaginal bleeding and cramping. The nurse advises her to go to the emergency department (ED) and tells the client that her provider and the RN in the ED will be notified.
Problem 14: Using the SBAR (situation, background, assessment, recommendation) format, in which order will the nurse communicate information in the report to the ED RN?
a. "The client is coming to the ED for evaluation for possible preterm labor and bleeding."
b. 2. "She has multiple high-risk pregnancy factors, including an elevated 1-hour glucose level, positive chlamydia test, and an abnormal Pap test result. She's had only two prenatal visits and no ultrasound yet. The client smokes cigarettes; reports a lot of stress; and is single, unemployed, and with little support."
c. 3. "The client is a 20-year-old G1P0 at 24 weeks' gestation who reports vaginal bleeding and cramping starting this evening."
d. 4. "Please be sure she also gets a social work consult and ensure that she has taken the prescribed azithromyc in 1 gram to treat the chlamydia infection."
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Attachment:- Case Study-Antepartum.rar