GROUP 1

The Growing Fetus

CD PATIENT SCENARIO

CARE STUDY: A PREGNANT WOMAN WITH CONCERNS FOR HER FETUS

Jessica Menendez is a 20-year-old woman who is 20 weeks pregnant. You care for her in an

emergency room. She has been stabbed in her upper abdomen from an argument with her

boyfriend.

CHIEF CONCERN:

"Is my baby all right? What if the knife hit it?"

HISTORY OF CHIEF CONCERN:

Client and her boyfriend were arguing over who should have the last piece of popcorn in a bowl

when he stabbed her with a kitchen paring knife. Client has felt the fetus move since the incident;

movement feels "same as always." She states, “I know her body parts are still forming. If

something is hurt, will a new body part form?”

PERSONAL/SOCIAL:

Client lives in one-bedroom apartment. She has a high school education; unable to find

employment, especially since she’s been pregnant. Finances are provided by government

assistance. She names her landlord (Mrs. Rubins) as her most accessible support person. When

asked if she intended to continue relationship with boyfriend, she answered, "He ain't all bad.

Just has a bad temper." She does not intend to press charges against him for stabbing her.
PAST MEDICAL HISTORY:

Client had nephrosis as a preschooler; no apparent sequelae. One previous incident of intimate

partner violence when a previous boyfriend beat her and broke her wrist. She had no childhood

diseases such as mumps or chickenpox.

FAMILY MEDICAL HISTORY:

Mother died at age 36 of uterine cancer. Father's health history unknown. An aunt has "some

kind of heart condition."

PREGNANCY HISTORY:

Pregnancy planned “to make boyfriend settle down." Last Menstrual period: 1/27. Has had no

prenatal care; not taking prenatal vitamins. Alcohol consumption: "a beer to help me sleep at

night"; smokes two packs of cigarettes a day; states she takes no recreational or prescription

drugs.

GYNECOLOGICAL HISTORY:

Menarche at age 11 years; mild dysmenorrhea each month. Has been sexually active since age

13. Had gonorrhea at age 14 years; treated at city health center. Uses a diaphragm for

contraception. As client trusts her boyfriend to maintain a monogamous relationship, she does

not ask him to use a condom.

REVIEW OF SYSTEMS
Essentially negative; has noticed occasional constipation during pregnancy.

PHYSICAL EXAMINATION:

General Appearance: Pregnant appearing young adult woman in obvious emotional distress from

recent accident. Clothing is blood-stained over abdomen.

HEENT: Normocephalic. Eyes: Follows to all positions of gaze; red reflex present. Mucous

membrane appears pale. Ears: No redness; TMs mobile. Mouth: Midline uvula; two cavities

present in lower teeth. Four keloid linear scars, each approximately 2 cm long present on left

cheek.

Chest: Respiratory rate: 22 breaths per minute. No rales or rhonchi present. Good aeration all

lobes.

Abdomen: One-inch long linear incision type wound present 2 inches above umbilicus at

midline; wound oozing slight serosanguinous drainage. Uterus palpable at umbilicus. Fetal

movement felt by examiner. FHR: 155 beats per minute by fetal heart rate monitor. Mild uterine

contractions present on monitor (15 second duration every 5 minutes).

Genitalia: Normal female; no discharge or lesions or redness.

Extremities: Ecchymotic marks in the impression of a hand present on both upper arms. Well

demarcated ecchymotic marks approximately 2 x 3 cm present over tibia on both legs.