Nursing Management Of The Pregnancy At Risk Case Study

Chapter 20, Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

1. Maria is a Hispanic 30-year-old who has not carried a pregnancy to term. She developed systemic lupus erythematosus (SLE), or lupus, when she was 25 years old. Maria is a G4P0 and has had three previous fetal demises. She is currently at 32 weeks’ gestation and has been asymptomatic during this pregnancy. Maria has been taking a daily dose of prednisone to suppress flare-ups. (Learning Objective 7)

  1. What is the management of care for the remainder of Maria’s pregnancy?
  2. If Maria’s lupus remains stable, will she require any modifications to standard care for her labor and delivery?
  3. How will the management of Maria’s pregnancy change if she develops a flare?

2. Nikki is a 17-year-old G1P0 at 33 weeks’ gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing have the distinct odor of marijuana and tobacco smoke. You directly ask Nikki if she has been taking any other drugs besides marijuana. Nikki is surprised by the question and denies it. When you explain that you can smell it in her hair and on her clothing, she starts to cry and says, “Please don’t take my baby away from me.” After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking “pot” and cigarettes. She relates that she also consumes 4 to 5 caffeinated beverages per day. (Learning Objective 10 and 12)

  1. How do cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake affect Nikki’s pregnancy?
  2. What possible affects are there to Nikki’s baby from the maternal ingestion of these substances?
  3. What is the nursing care you would provide for Nikki?

Chapter 19, Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1 and 2)

  • Why is Teresa’s pregnancy considered a high-risk pregnancy?
  • What are the potential pregnancy-related complications for Teresa?
  • What are the potential risks to the babies?

2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)

  • What needs to be included in a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome?

Chapter 12, Nursing Management During Pregnancy

1. Nancy, age 38, and her husband, Dan, age 37, arrive at a midwife clinic for an initial prenatal visit. They have been married for 10 years and trying to have a child for 3 years. Nancy completes the initial paperwork and the nurse notes the following obstetrical history: G3, T0, P0, A2, and L0. Nancy is approximately 8 weeks pregnant. (Learning Objectives 2, 3, and 4)

  • What questions in the history are the highest priorities for the nurse to ask, given Nancy’s obstetrical history? Why is this history important?
  • What initial prenatal screening and testing would the nurse anticipate at this visit? Why?
  • What prenatal screening and testing would the nurse anticipate for Nancy in the future related to her age? Why?

2. Carla is 36 weeks pregnant with her first child. She is in the office for her regular prenatal checkup. During this visit she complains of increasing heartburn, low back pain, constipation, and difficulty sleeping at night. Carla would like to know what she can do to get relief from these symptoms. (Learning Objectives 5 and 6)

  • What needs to be included in the nursing management for Carla’s complaints?
  • Now that Carla is nearing the end of her pregnancy, she has many questions regarding what to include as she starts preparing her birth plan. What information does Carla need to effectively plan for the birth of her baby?

Expert Solution Preview

Introduction:

In this assignment, we will be discussing various scenarios related to nursing management during pregnancy. Each question will address a specific case scenario and the associated learning objectives.

Answer to Question 1:

1. For Maria, who is a Hispanic 30-year-old with SLE, the management of care for the remainder of her pregnancy involves close monitoring by a healthcare provider who has expertise in managing high-risk pregnancies. Maria should continue taking her daily dose of prednisone to suppress flare-ups and receive regular fetal monitoring to monitor fetal well-being. In addition, Maria’s care provider should monitor her kidney, liver, and platelet function. If her health deteriorates, early delivery may be necessary.

If Maria’s lupus remains stable, she will not require any modifications to standard care for her labor and delivery. However, if Maria develops a flare during pregnancy, she may require hospitalization, intravenous fluids, and corticosteroids or other immunosuppressive drugs to manage the flare and prevent further complications.

Answer to Question 2:

2. Cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake can all have adverse effects on Nikki’s pregnancy. Cigarette smoking and marijuana use increase the risk of preterm birth, low birth weight, and sudden infant death syndrome (SIDS).

Binge alcohol consumption can cause fetal alcohol spectrum disorders (FASDs), which can cause physical and intellectual disabilities that can last a lifetime. Excessive caffeine intake can also increase the risk of preterm birth and low birth weight.

The maternal ingestion of these substances can also cause withdrawal symptoms, respiratory depression, and developmental delays in the baby.

The nursing care that should be provided for Nikki is a non-judgmental and supportive approach that will help her make healthier choices. This includes providing education on the potential dangers of smoking, drinking, and drug use during pregnancy and offering her resources for quitting. Additionally, the nurse should make referrals for prenatal care and substance abuse treatment as needed.

Answer to Question 3:

1. Teresa’s pregnancy is considered a high-risk pregnancy because she is carrying twins, which increases the risk of complications such as premature birth, preeclampsia, and gestational diabetes. Additionally, Teresa’s pregnancy was achieved through in vitro fertilization.

The potential pregnancy-related complications for Teresa include preeclampsia, gestational diabetes, preterm labor, placental abnormalities, and fetal growth restriction.

The potential risks to the babies include preterm birth, low birth weight, and developmental delays.

Answer to Question 4:

2. For a woman experiencing preeclampsia, eclampsia, and HELLP syndrome, the plan of care should include close monitoring of vital signs, fluid and electrolyte balance, and fetal well-being. Depending on the severity of the condition, hospitalization and delivery may be necessary to prevent further complications.

The woman should be placed on bed rest and advised to limit physical activity. Antihypertensive medication may be prescribed to manage high blood pressure and prevent seizures. Additionally, magnesium sulfate may be given to prevent seizures in women with severe preeclampsia and eclampsia.

Answer to Question 5:

1. Given Nancy’s obstetrical history, the highest priorities for the nurse to ask include the length of time between pregnancies, any complications during previous pregnancies, and any chronic medical conditions. This history is important because previous complications or medical conditions can increase the risk of complications in subsequent pregnancies.

The initial prenatal screening and testing that the nurse would anticipate for Nancy at this visit includes blood tests to check for anemia and blood type, a Pap smear, and a urine test to check for infection or kidney problems. This is done to establish a baseline for the pregnancy and identify any potential complications early on.

As Nancy is advanced in maternal age, the nurse would anticipate additional prenatal screening and testing, such as genetic counseling and testing for chromosomal abnormalities, as well as testing for gestational diabetes and hypertension, both of which are more common in older pregnant women.

Answer to Question 6:

1. For Carla’s complaints of heartburn, low back pain, constipation, and difficulty sleeping, nursing management should include education on lifestyle modifications, such as eating smaller meals, avoiding certain foods, performing back exercises, and practicing relaxation techniques. Additionally, pharmacological interventions may be needed, such as antacids for heartburn or laxatives for constipation.

Regarding birth plan preparation, Carla needs to discuss the available options for pain management, including non-pharmacological techniques, such as breathing techniques and massage, and pharmacological interventions, such as epidural anesthesia. Additionally, Carla should discuss her preferences regarding fetal monitoring, labor and delivery positions, and who she would like to have present during delivery.

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