Question

Antepartum Case Study

P.M. comes to the obstetric (OB) clinic because she has missed 2 menstrual periods and thinks she may be pregnant. She states she is nauseated, especially in the AM, so she completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician.

1. What are the two most important questions to ask to determine possible pregnancy?

2. She tells you she has never been pregnant. How would you record this information?

3. What additional information would be needed to complete the TPAL record?

4. It is important to complete the intake interview. What categories should you address with P.M.? CASE STUDY PROGRESS According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the physician or nurse-midwife does a physical examination, including a pelvic exam, and confi rms P.M. is pregnant, the fetus is at approximately 6 weeks’ gestation, and she has a gynecoid pelvis by measurement.

5. How would you calculate her due date?

CASE STUDY PROGRESS

Pregnancy is divided into 3 trimesters, each lasting about 3 months. Nursing interventions focus on monitoring the women and fetus for growth and development; detecting potential complications; and teaching P.M. about nutrition, how to deal with common discomforts of pregnancy, and activities of self-care. 6. A psychologic assessment is done to determine P.M.’s feelings and attitudes regarding her pregnancy. How do attitudes, beliefs, and feelings affect pregnancy?

Answer 1

1.The two most important questions to determine possible pregnancy are

• Her last menstrual period ,this at times helps to confirm pregnancy with other pregnancy related symptoms
• Has she planned for pregnancy and will be able to continue if pregnant
• Is she using any drug which can affect the feral growth and lead yo fetal abnormality if pregnant
• The recent physical changes in her body (morning sickness, breast tenderness or heaviness,constipation,fatigue ,dizziness, pica ,etc.,)

2.A women who is not pregnant before or has given birth to a baby or a delivery should be recorded as nulliparous or nullipara.

3.The reproductive life or a gestational life is graded on the basis of TPAL

• Term birth:babies born after 37 weeks of gestation
• Preterm birth refers to baby born before 37weeks of gestation
• Abortion :This can be miscarriage, medical termination of pregnancy
• Live :The number of live children

The additional information to be asked about is the current pregnancy (which is mentioned as G -Gravida).It describes about first pregnancy (primi Gravida ) or second or the consequent pregnancies (multigravida)

4.The intake interview is the first interaction of a patient to the healthcare professionals. The following categories to be addressed before visiting a physician

• Past medical and surgical history
• A mental status examination is done whether PM is prepared and ready to accept this pregnancy
• Any use of medication,drug ,alcohol,smoking, tobacco
• History of any allergy
• Dietary patterns
• Basic vital signs (TPR,BP,RBS,height and weight)
• Present complaints