Module 03 Case Study – Assessment of Pregnant Client

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 an 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?