Question

Case Studies,

Chapter 12, Nursing Management During Pregnancy

1. Nancy, age 38, and her husband, Dan, age 37, arrive at a midwife clinic for an initial prenatal visit. They have been married for 10 years and trying to have a child for 3 years. Nancy completes the initial paperwork and the nurse notes the following obstetrical history: G3, T0, P0, A2, and L0. Nancy is approximately 8 weeks pregnant. (Learning Objectives 2, 3, and 4)

1. What questions in the history are the highest priorities for the nurse to ask, given Nancy’s obstetrical history? Why is this history important?

2. What initial prenatal screening and testing would the nurse anticipate at this visit? Why?

3. What prenatal screening and testing would the nurse anticipate for Nancy in the future related to her age? Why?

2. Carla is 36 weeks pregnant with her first child. She is in the office for her regular prenatal checkup. During this visit she complains of increasing heartburn, low back pain, constipation, and difficulty sleeping at night. Carla would like to know what she can do to get relief from these symptoms. (Learning Objectives 5 and 6)

1. What needs to be included in the nursing management for Carla’s complaints?

2. Now that Carla is nearing the end of her pregnancy, she has many questions regarding what to include as she starts preparing her birth plan. What information does Carla need to effectively plan for the birth of her baby?

Answer 1

1)A) The nurse would seek further information about the documented abortions in Nancy's obstetrical history. Information to gather would include the year/ date of abortion, if the abortions were spontaneous ( miscarriage) or induced and weeks of gestation at the time of the abortion.

This history is important so that any areas such as health problems, lifestyle habits or social concerns that might unfavorably affect pregnancy are identified. If the abortions were spontaneous, the nurse could ask about any related tests or diagnosis. The nurse would then be able to provide honest, supportive information and provide the health care provider with all data gathered during the history process to see if Nancy will be considered as high risk pregnancy.

B) The nurse would plan to do a complete head to toe physical examination, including height, weight and blood pressure. In addition, the nurse would plan for a pelvic examination. The pelvic examination would provide the health care provider with more information on the presumptive and probable signs of pregnancy. The nurse would plan to complete a full history, including the woman's reproductive history. Laboratory studies could include Urinalysis, blood type and Rh, Complete blood cell count, Rubella titer, Hepatitis B, HIV testing, VDRL, RPR testing to test for syphilis, STD screening and Cervical smears.

These tests and screenings would be needed to provide a total picture of Nancy's health and would assist in planning for the pregnancy.

C) Due to Nancy's age being 38 years old, she is considered to be of advanced maternal age and is in high risk category for pregnancy complications. Tests for Nancy could include Ultrasonography, Alpha-fetoprotein analysis ( AFP levels) , triple marker screen, amniocentesis, nonstress test and biophysical profile.

These screenings and tests would be done because when a pregnancy is identified as high risk, further antepartum testing is often completed to promote positive maternal , fetal and neonatal outcomes.

2) A)For the heartburn, nurse review her dietary intake, have her limit gas producing foods, fatty foods and eats small frequent meals.Remain sitting for 1-3 hours after a meal. Avoid foods that aggrevate the heartburn.

For backache, have keep head and shoulder erect, avoid lifting heavy objects, use foot supports and pillows behind back and sleep with pillows between knees .

For constipation, have her eat fresh fruit, raw vegetables, whole grains cereals and breads daily along with increase walking as tolerated , drinking 6-8 glasses of water per day and drinking warm fluids .

For sleep, have her stay on a regular schedule. Take time to relax and unwind before bed. Try Reducing the lighting in the bedroom and make room temperature cooler. Avoid caffeine and limit fluid intake before bedtime.

B) The information Carle needs to effectively plan for birth of her baby are perinatal education, childbirth education, Lamaze psych prophylactic method which focuses on breathing and relaxation techniques. Bradley - partner coached childbirth method which focuses on exercises and slow, controlled abdominal breathing, Dick - Read natural childbirth method which focuses on fear reduction via knowledge and abdominal breathing techniques. Information on feeding choices disadvantages and advantages for breast feeding and bottle feeding. Teaching and final preparations for labor and birth.