Case Study #129 - Antepartum (Prenatal) PDF

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Case Study 129 – Antepartum (Prenatal)

Scenario: P.M. comes to the Obstetric Clinic because she has missed two menstrual periods, and she thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test; the result 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 P.M. to determine possible pregnancy? a. Have you recently had sexual intercourse? b. Are you using any kind of contraceptives or practicing safe sex? c. When was your first day of your last menstrual period?

2. You ask if she has ever been pregnant, and P.M. tells you she has never been pregnant. How would you record this information? Gravida: 1

Para: 0

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

term births P: L: living children

premature births

A:

abortions

4. It is important to complete the intake interview. What categories will you address with P.M.? a. Family history b. Medical history c. Medications, drug/alcohol use d. Contraceptives being used e. Social history f. Occupational history g. Support system h. Financial history i. Thoughts/feelings towards surgery j. Symptoms she has been having k. Information about partner (history) l. Vaccinations

m. n. o. p.

Gynecology history Breast surgery (implants/reductions) Nutritional history Eating disorders

Case Study Progress: According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type and Rh factor, urine for urinalysis (protein, glucose, blood), vital signs, height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic examination and confirms that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks’ gestation. Vital sign findings are as follows: BP 116/74, T. 98.9°F, P. 88 bpm, and R. 16/min.

5. Do any of these vital signs cause concern? What should you do? a. Vital signs all within normal limits and no further action needs to be taken

6. P.M. tells you that the date of her last menstrual period (LMP) was February 2. How would you calculate her due date? What is her due date? a. Rule of calculation is Nagele’s rule done by getting LNMP and subtract 3 months from and began and add 7 days (40 weeks) November 9th

7. What is the significance of a gynecoid pelvis? a. This type of pelvis will make it easier for the childbirth, the ideal shape of the pelvis

a

8. What specimens are important to obtain when the pelvic examination is performed? a. Cervical smear b. Cytological smear c. Group B strep d. Pap screen e. HPV f. Chlamydia/gonorrhea

Case Study Progress: Nursing interventions focus on monitoring the woman 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. 9. A psychological assessment is done to determine P.M.’s feelings and attitudes regarding her pregnancy. How do attitudes, beliefs, and feelings affect pregnancy? a. A woman that is happy to be pregnant is likely to take care of herself and newborn than a women who does not want to be pregnant b. First trimester mother might be scared of telling others and how her life will be changing c. Second trimester, her body will change and will focus on small details of her body d. Third trimester may feel vulunerable

10. P.M. asks you whether there are any foods that she should avoid while pregnant. She lists some of her favorite foods. Which foods, if any, should she avoid eating while she is pregnant? Select all that apply. a. b. c. d. e.

Hot dogs Sushi Yogurt Deli meat Cheddar cheese

11. As the nurse, you know that assessment and teaching are vital in the prenatal period to ensure a positive outcome. What information is important to include at every visit and at specific times during the pregnancy? a. First 28 weeks every 4 weeks, urinalysis, vitals, fetal movements, weight, edema b. Ask about stress, diet, readiness c. After 28 weeks every 2 weeks ask about classes, ready bag/prepping for baby d. 34-36 weeks every week

12. After her examination, P.M. states that she is worried because her sister had an ectopic pregnancy and had to have surgery. She asks you, “What are the signs and symptoms of an ectopic pregnancy?” Which of these are correct? Select all that apply. a. b. c. d. e.

Fullness and tenderness in her abdomen, near the ovaries Pain, either unilateral, bilateral, or diffuse over the abdomen Nausea Dark red or brown vaginal bleeding Increased fatigue

13. P.M. asks the nurse about what should be reported to her doctor. List at least 6 of the danger signs during pregnancy. a. Bleeding b. Change in fetal activity c. Burning during urination

d. e. f. g. h. i. j.

Fever Edema of hands and feet Vision changes (HTN) Severe vomiting Severe abd pain Gushing of fluids or trickling of fluid Persistent headache (HTN)

14. Changes in the body caused by pregnancy include relaxation of joints, alteration to center of gravity, faintness, and discomforts. These changes can lead to problems with coordination and balance. In teaching P.M. about safety during pregnancy, what will you include in your teaching? a. Wearing proper shoes b. Mindful of posture and body mechanics c. Wearing a seatbelt d. Simply being careful

15. P.M. asks, “Is a vaginal examination done at every visit?” Select the best response and explain your answer. a. “Yes, an examination is done with each visit because it allows the examiner to note any possible infections that may be developing.” b. “Yes, an examination is done with each visit because it offers vital information about the status of the pregnancy.” c. “No, a vaginal examination will not be done again until you go into labor.” Limit the risk of infection d. “No, vaginal examinations are not routinely done until the final weeks of your pregnancy.”

Case Study Outcome: P.M. makes an appointment for her next checkup. You tell her that an ultrasound may be done at about 8 to 12 weeks’ gestation to check fetal growth....