Question

maternal health case study

case study #1 19 y.o. Pt presents to L&D at 39 5/7 weeks gestation, G1TOPOAOLO c/o headache and abdominal pain. Her pregnancy was unplanned, but her boyfriend is supportive. Pt is GBS pos, all other prenatal labs were WNL. Pt denies contractions, bleeding, leaking, and confirms fetal movement. What are the priority assessments for this patient upon admission? What risk factors does this patient have? After initial assessments, the ptis vital signs are BP 160/100, HR 90, RR 20, T 37.6. FHT's are reassuring, baseline 140, good variability and accelerations noted. What additional assessments should you as the RN do, what is the priority information to discuss with the provider, and what additional interventions would be appropriate? After discussing this with the provider, orders are received for IV Labetalol, CBC, AST/ALT, Protein/Creatinine Ratio, and SVE. The abnormal labs are: AST 340, ALT 400, Platelets 100, Protein/Creatinine Ratio 0.4. Her cervix is 2 cm dilated, 80% effaced, -2 station. What diagnosis would you anticipate for this patient and what is your priority assessments/interventions? The OBGYN arrives at bedside, orders Magnesium Sulfate IV and an Oxytocin Induction. What are your priorities for this plan of care and what education would you give to the patient regarding this plan of care? What risk factors does this patient have for her labor and recovery?

Answer 1

The priority assessment of this patient are

• Vital signs:can provide baseline information, headache could be possibly because of elevated blood pressure ,can be a sign of pre eclampsia
• Assessing the abdominal pain for Braxton hick contraction because it is possible to have false contractions prior to true labor
• Assessment for cervical dilatation to be done.
• Assessing the patient from any other infectious disease like HIV, HCV,Hepatitis B
• Blood investigations to rule out the hemoglobin levels
• Assessing the fetal heart rate by fetal doppler

The patient has risk factors of infecting her baby due to GBS infection, risk of seizure during labour is possible, pre term birth

The first information to be discussed with the physician

• is finding orders to decrease her elevated blood pressure levels by medication
• Orders to carry out any blood investigations
• Placing the patient in comfortable position
• Reassuring the patient
• If headache doesn't settles down report the provider for medical intervention
• Inserting and IV cannula to infuse antibiotic to prevent infection to baby during delivery

The possible diagnosis for this patient is HELLP syndrome where the liver enzymes AST,ALT are elevated and there is a decrease in platelets along with thus the patient may have headache and abdominal pain

The priority assessment and intervention are

• Maintain the blood pressure under control to prevent pre eclampsia
• Assess for any bleedi mb g or discharge
• Preparation of patient for surgical intervention for cesarean section to prevent complications

Inform the patient about the procedure ,assess patient's neurological status start administering magnesium sulphate via intravenous route this can relax the uterine contraction and prevent patient from seizure attacks .The oxytocin will lead to contraction and initiating the labor process.

The risk factor of infection and slow recovery due to elevated blood pressure and high risk for hemorrhage.