Question

Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared.

1. What is the Etiology/Pathophysiology for this patient case?

2. What are the Scientific Rationale for Interventions for this patient case?

3. Write How You Would Evaluate Your Plan for this patient case.

4.. List of Medications Typical for the Medical Dosage; side effects for this patient.

5. Education consideration.

Answer 1

1. The etiology of twin pregnancy monozygotic is unknown, dizygotic occurs due to ovulation of multiple follicles caused by elevation in serum gonadotrophin levels.

In the case of IVF the multiple embryos may be inserted into the uterus to increase the chance of pregnancy. This would lead to implantation of more than one embryo in the uterine lining causing the twin pregnancy

2. The multiple pregnancy requires the proper care from the prenatal conception itself. They require proper:

* nutrition

* frequent prenatal visits

* physician referrals

* complete rest

* maternal and fetal monitoring

* administration of tocolytics to prevent preterm labour

* education regarding the mode of delivery and related complications

* demonstrating relaxation techniques to reduce her anxiety levels

* clear all the doubts of the patient by encouraging her to ask her doubts

* assessing fetus and administering corticosteroids for the lung maturity

3. The plan of care evaluated for this patient is:

* complete assessment

* prioritising needs and problems

* fetal and maternal monitoring.

* monitoring for iuds fetal development

* assess the fetal movement count.

4. Here the medications for this patient is for the risk of prematurity the tocolytics can be administered based on long term or short term therapy. Betamethsone or dexamethasone class. For instance ritodrine can be given 50mg in 500ml of 5% glucose solution. Start up with 10drops and increase 5drops after 10min.

Side effects: maternal: tachycardia, hypotension, flushing, sweating nausea, vomiting, hyperglycemia, hypokalemia

Fetal: tachycardia, arrhythmia,

Neonatal hypotension and hypoglycemia.