Question

Today’s prenatal visit: Kathie can’t believe that she is pregnant since she had been douching for birth control every time she had intercourse. She complains of excessive vomiting and states that she has lost 10 pounds in the past two weeks. Other complaints include intermittent chills, pain in the lower right back area, and pain with voiding. She has dark circles under her eyes, and her mucus membranes are dry and pale. Her vital signs are: BP 108/68, T 103.8 F, P 88, and R 22.

Upon examination, the midwife notes:

1. Right side, cervical lymph glands are enlarged and tender
2. Need dental work on two of her upper right molars
3. Fundal height is three fingers below the umbilicus
4. FHT are heard in the LLQ (130s)
5. When doing her PAP the midwife notes that she has a homogenous gray clinging discharge with a pH of 5
6. Urine chemistrip in the office is positive for ketones, nitrites, and leukocytes; negative for glucose and protein

Kathie is given HIV counseling and agrees to be tested. Her HIV test comes back negative.

Answer the following questions:

1. If Kathie’s size equals her dates, about how many weeks pregnant do you think she is?
2. Why do you think she put off coming in for prenatal care for so long?
3. How important is it that her due date be established at this first visit?
4. In light of Kathie’s advanced gestation and weight loss, how significant is her nausea and vomiting?
5. Which of Kathie’s signs and symptoms point to a urinary tract infection?
6. What are the implications of UTI for pregnancy?
7. What are the implications of dental caries/infections for pregnancy?
8. Discuss common misconceptions teens have about contraception.
9. Make a list of topics the nurse should discuss with Kathie as a result of the initial exam.

In light of Kathie’s reading level, how will the nurse provide education?

Answer 1

As Kathie's fundal height is 3cm below umblicus ,she should be in her 17th week of pregnancy (At umblicus the fundus is 20 weeks,the measurement is with the number of fingers subtracted 20_3=17weeks)

Some of the reason for her to postpone her visit may be her douching practice (would made her think that she cannot be pregnant if douching is done),knowledge deficiency, might have not experienced any discomfort

It is very important to establish  her due date because

• To assess the foetus growth
• The necessity to take supplementary to prevent congenital anamoly as neural growth occurs in first trimester
• To assess whether the foetus has any abnormalities due to mother's present conditions
• To do the basic blood investigation done in antenatal period
• To administer Tetanus toxoid injection

The nausea and vomiting settles down with the progression in pregnancy usually coming to an end by first trimester.She is experiencing this in her second trimester with weight loss in 2 weeks which makes concerned and to rule out the secondary cause.

The signs and symptoms which points her urinary tract infection are

• Fever (raise in temperature of 103°F),intermittent chills
• Pain while voiding
• Pain in lower right back area
• Leukocyte and nitrate in urine

Some of the implications of UTI for pregnancy are

• Increasing fluid intake to prevent the effects of fluid loss
• Take antibiotics as per the order during pregnancy to prevent infection
• Maintain personal hygiene (especially special care to keep private area clean to prevent infection ),pat it dry after bowel and bladder movements
• No douching or relationship with infected partner
• Take medication as per order (Vitamin C,Zinc and Beta carotene )

Some of the implications of dental carries for pregnancy are

• Antibiotics and pain killers as per advice
• Use of mouth gargles
• Rinse the mouth after food
• Maintain good oral care (brushing ,flossing)
• Crowning and cavity filling can be done ,the procedures are almost safe during second trimester, Doing this will prevent the foetus from infection and birth defects.

The common misconception about pregnancy among the teens are

• The chance of getting pregnant during first intercourse is not possible
• Birth control techniques will prevent pregnancy ,emergency pills
• Withdrawing before ejaculation in boys and during periods in girls

The following health education are needed fir Kathie

• Proper ante natal care
• Nutritious food to increase her weight required for healthy pregnancy
• Infectious control practices
• Avoiding birth control methods or intercourse
• Oral hygiene
• Vitamin supplements as per order

The nurse has to educate the client in the most basic language so that it is understandable by her and follow