Assessment Of A Pregnant Woman

 

Utilize the appropriate technology and/or references/resources, demonstrating accurate use, in order to access reliable data and information that support evidence-based practice in the care of diverse clients during pregnancy.
Differentiate the various components of basic physiological needs as it relates to pregnancy and health practices, including but not limited to associated concepts of.
Evaluate data and information gathered during client care, simulated scenarios, and/or case studies related to promoting nutritional health during pregnancy, nursing care strategies to address the common discomforts of pregnancy, essential components and standards of prenatal care, fetal growth and development stages in order to determine knowledge and wisdom gained through critical thought processes to optimize client outcomes and quality improvement.
Demonstrate a basic understanding of communication practices necessary for client-centered care and interdisciplinary collaboration in terms of knowledge, skills, and attitudes.
Competency
Apply appropriate nursing care interventions for clients during pregnancy, labor, and birth.

Scenario

You are a registered nurse (RN) working in a Women’s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jones’s medical and obstetrical history is as follows.

Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papilloma virus (HPV), colposcopy within normal limits

Medical history: Chronic hypertension (HTN) x 5 years;

Allergies: Penicillin

Social history:
(+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” for 15 years
(+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use
Abusive partner with first pregnancy, states she has a new partner x 4 years
Depression, currently not taking meds for treatment (tx)
Medications: Prenatal vitamins; Labetalol 200mg BID;

Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)

Instructions
Write a two to three-page analysis of this scenario that answers the following questions:

What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression?
Document the considerations of yourself as the professional nurse in regards to self-awareness; be aware of attitudes, values and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.
What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?
What concerns should be discussed with Ms. Jones before she leaves her appointment?

Sample Solution

Comprehensive Care for Elizabeth Jones: A Multifaceted Approach

Elizabeth Jones’ case presents a complex medical and social history requiring a holistic approach to prenatal care. Here’s a breakdown of key considerations:

Considerations for Clients with Diverse Backgrounds:

Domestic Abuse:

Drug Use:

  • Assessment:Assess for current drug use and potential for relapse. Consider using resources like the National Institute on Drug Abuse (https://nida.nih.gov/) for screening tools and treatment information.
  • Education:Educate Ms. Jones on the risks of drug use on fetal development.
  • Treatment Resources:Offer support groups and addiction treatment programs (https://findtreatment.gov/).

Sexually Transmitted Infections (STIs):

  • Investigation:Investigate the type and treatment of previous abnormal PAP smears and HPV. Consider consulting reliable sources like the CDC for STI testing guidelines (https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm).
  • Testing:Consider testing for other STIs if deemed necessary.
  • Treatment:If positive, initiate appropriate treatment to prevent transmission to the fetus.

Depression:

  • Screening:Use standardized tools like the Edinburgh Postnatal Depression Scale (EPDS) to screen for current symptoms of depression (https://cks.nice.org.uk/topics/depression-antenatal-postnatal/).
  • Mental Health Referral:Refer Ms. Jones to a mental health professional for assessment and treatment.
  • Medication Safety:Discuss the safety of medications during pregnancy and explore alternative therapies like cognitive behavioral therapy (CBT).

Self-Awareness for the Nurse:

As the nurse, it’s crucial to be self-aware of your own biases and assumptions regarding Ms. Jones’ background. Here’s how to ensure your care is not negatively affected:

  • Acknowledge Your Values:Reflect on your own values and beliefs regarding domestic abuse, drug use, mental health, and socioeconomic status.
  • Empathy and Non-Judgment:Practice empathy and non-judgmental communication to create a safe space for Ms. Jones.
  • Strengths and Resources:Focus on Ms. Jones’ strengths and resources to empower her.
  • Confidentiality and Respect:Maintain confidentiality and respect Ms. Jones’ privacy throughout the interaction.

Conditions of Concern During Pregnancy, Labor, and Birth:

  • Chronic Hypertension (HTN):
    • Close monitoring of blood pressure throughout pregnancy is crucial.
    • Labetalol dosage may need adjustment in consultation with the doctor.
    • Increased risk of preeclampsia, a serious pregnancy complication requiring close monitoring.
  • Previous Cesarean Section (C-Section):
    • Discuss the possibility of vaginal birth after cesarean section (VBAC) with Ms. Jones and the doctor.
    • Increased risk of uterine rupture during labor.
    • Delivery plan will depend on Ms. Jones’ preference and doctor’s assessment based on medical history and current pregnancy.
  • Abnormal PAP Smear and HPV:
    • Monitor for any changes in cervical cells during pregnancy.
    • Increased risk of cervical cancer, although not a major concern during pregnancy.

Concerns to Discuss with Ms. Jones Before Leaving:

Domestic Violence:

  • Safety Concerns:Discuss safety concerns and offer support resources and a safety plan in case of abuse.
  • Empowerment:Encourage Ms. Jones to reach out for help if needed. This could involve involving a trusted friend or family member or contacting a local shelter.

Drug Use:

  • Importance of Abstinence:Emphasize the importance of abstinence from drugs for the baby’s health.
  • Withdrawal Symptoms:Discuss potential withdrawal symptoms and offer support systems to help her through them.

Mental Health:

Prenatal Care:

  • Schedule Follow-up Appointments:Schedule regular prenatal care appointments to monitor the pregnancy and fetal development.

 

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