Question

A 37-years-old Mary K., is 37-years-old mother presents to the prenatal clinic after missing her last 2 menstrual cycles. She reports that her home pregnancy test was positive. An ultrasound confirms pregnancy and calculated 10 weeks of gestation. Her medical history reveals that she had uncomplicated spontaneous delivery at 38.5 weeks 5 years ago. Three years ago she has Cesarean delivery at 37.5 weeks due to non- reassuring fetal heart tone. Both children are healthy and live with her and her husband in suburbs of Minneapolis. She also reports elective abortion at age 19 Mary also reports treatment for chlamydia 7 years ago and positive HPV. Her medical history reveals chronic hypertension (HTN) and daily Propranolol 15 mg ntermittent but well managed asthma with Albuterol inhaler PRN. Mary reports strong family history of insulin-dependent diabetes mellitus (mother) and HTN (father) Her social history: history of marijuana use in early 20th, occasional alcohol use, tobacco use (quit a year ago), abusive partner with first pregnancy, but has a new partner for the last 4 years and history of depression woman at 10 weeks gestation Questions: 1. Based on Mary's OB/GYM history, what is her GTPAL? 2. What should the nurse consider related to caring for a patient with history of illegal substance use, sexually transmitted diseases, depression history of domestic abuse? (address each) 3. What laboratory and assessment data should be collected during this prenatal visit? 4. Based on Mary's medical and social history, she is at greater risk for which pregnancy complications? 5. What are the priority teaching points for discuss with Mary before she leaves the clinic today?

minimum of two hundred words please

Answer 1

1.The GTPAL stands for Gravida,Term birth,Preterm birth,Abortion, Live

Gravida:total no.of pregnancy=4

Term :delivery after 37 weeks=2

Preterm :born before 37 weeks=0

Abortion=1

Live=2

Ans:G4T2P0A1L2

2.The nurse should consider the following

• Substance abuse
  • Health educate about the harmful effects of substance abuse
  • Screen the fetus for any abnormality
  • Assess mother for current usage or the risk for abuse
• Sexually transmitted disease
  • Assess the mother's immunization history
  • Assessment for any signs of infection
  • Administer medication as per order to prevent transmission of infection to fetus and causing congenital anomaly
• Depression/domestic abuse
  • Enroll her in ante natal program
  • Provide psychological support to come out of depression
  • Assess familial support for help to avoid being victim of domestic violence

3.The following laboratory and assessment data to be collected

• Screening test for sexually transmitted diseases like HIV,HCV,HbsAg, syphilis, gonorrhea, VDRL,Hepatitis C
• Ultrasound to assess the fetal growth

4.She is at greater risk for the following

• Pre eclampsia due to hypertension
• Gestational diabetes due to history of maternal diabetes
• Low birth weight babies
• Premature birth
• Toxemia
• Still birth