Ylarde, Melany Vanz A.

CASE SCENARIO I: ELLA

QUESTIONS:

1. Determine the EDC and AOG of Ms. Ella.

AOG= 4 weeks and 6 days.

2. Define PARA, GRAVIDA, NULLIPARA, MULTIPARA.

-PARA- Any woman who has given birth once or more is termed a "para."
-GRAVIDA-
a pregnant woman, which is modified by the number of times she has been pregnant, regardless of the number of infants delivered at term; thus a woman pregnant for the fi
rst time is a primigravida, for the second time, secundigravida, etc.
-NULLIPARA - a woman who has never given birth to a viable child.
-MULTIPARA-
A woman who has given birth at least twice to an infant, liveborn or not, weighing 500 g or more, or having an estimated length of gestation of at least 20 weeks.
3. What is Ms. Ella Gravida and Para utilizing the GTPAL?
- G3 T2 P1 A0 L2
4. Briefly discuss psychological responses or behavior as seen in Ms. Ella as she adjusts to pregnancy during the 1st trimester.
- Tender, swollen breasts. Soon after conception, hormonal changes might make your breasts sensitive or sore. The discomfort will likely decrease after a few weeks as
your body adjusts to hormonal changes.
- Nausea with or without vomiting. Morning sickness, which can strike at any time of the day or night, often begins one month after you become pregnant. This might
be due to rising hormone levels. To help relieve nausea, avoid having an empty stomach. Eat slowly and in small amounts every one to two hours. Choose foods that are
low in fat. Avoid foods or smells that make your nausea worse. Drink plenty of fluids. Foods containing ginger might help. Contact your health care provider if your
nausea and vomiting is severe.
- Increased urination. You might find yourself urinating more often than usual. The amount of blood in your body increases during pregnancy, causing your kidneys to
process extra fluid that ends up in your bladder.
- Fatigue. During early pregnancy, levels of the hormone progesterone soar — which can put you to sleep. Rest as much as you can. A healthy diet and exercise might
increase your energy.
 - Food cravings and aversions. When you're pregnant, you might become more sensitive to certain odors and your sense of taste might change. Like most other
symptoms of pregnancy, food preferences can be chalked up to hormonal changes.
- Heartburn. Pregnancy hormones relaxing the valve between your stomach and esophagus can allow stomach acid to leak into your esophagus, causing heartburn. To
prevent heartburn, eat small, frequent meals and avoid fried foods, citrus fruits, chocolate, and spicy or fried foods.
- Constipation. High levels of the hormone progesterone can slow the movement of food through your digestive system, causing constipation. Iron supplements can add
to the problem. To prevent or relieve constipation, include plenty of fiber in your diet and drink lots of fluids, especially water and prune or other fruit juices. Regular
physical activity also helps.

5. Identify and discuss the physiological changes based on each organ system that Ms. Ella might experience during this state.

- Thinning and shortening of the cervix

- Widening and enlargement of the cervical OS and canal

6. Identify at least 5 discomforts that she might experience during the first trimester and discuss independent nursing intervention for each.

- Fatigue-Many women experience fatigue and exhaustion in the first trimester. This is one of your body's normal ways of reacting to hormonal changes that are taking
place in early pregnancy. To help ease the fatigue try to get at least eight hours of sleep every night and a nap during the day when possible.  For other suggestions visit the
page fatigue during pregnancy.-

- Morning Sickness- Nausea and vomiting, usually called "morning sickness," are common during early pregnancy. However, for many women it is not limited to just the
morning and often appears at other times.  The nausea and vomiting usually go away after the first trimester. For additional information please visit the morning sickness.
When you vomit you lose body fluid.  If you lose too much fluid you can become dehydrated which can be dangerous for you and your baby. If you think you are vomiting
excessively call your doctor.

- Frequent Urination- Early in pregnancy the growing uterus presses on your bladder and this can cause frequent urination.  Make sure to contact your health care provider
if you notice pain, burning, pus or blood in your urine.

- Weight Gain- During the first trimester, it is normal for you to have gain, about one pound per month for the first 3 months.
 - Changes in your baby- By the end of the first trimester your baby is about 3 inches long and weighs about half an ounce. The eyes move closer together into their
positions, and the ears also are in position. The liver is making bile, and the kidneys are secreting urine into the bladder. Even though you cannot feel your baby move yet,
your baby will move inside you in response to pushing on your abdomen.

7. What is the significance of proper diet and nutrition to a pregnant woman? Discuss healthy eating habits and vitamins needed for her and her growing fetus.

- Proper diet and enough vitamins should be taken by a pregnant women to support her doing feeders and her baby to become healthy when it goes out also this will help
the baby become more immune from viruses and the mother should eat balance as the right eating schedule and avoid unhealthy foods and skip meals in a day and should
exercise very light aerobics to maintain healthy pregnancy.

8. What are the discomforts of pregnancy on the first trimester that should be discussed to Ms. Ella so she would understand better? Include independent nursing
interventions for each.
- Discomfort of Ella in this 1st trimester is morning sickness and urine frequency. Because of the hormonal changes like estrogen enlargement of breast and may others that
will affect her psychological and physical. As a Nurse you should tell ella that this is normal during her 1st trimester of pregnancy and she should not be afraid of the
changes of her body. And advise her to eat proper diet and rest for this time.

9. Formulate Nursing Diagnosis – based on identified problem of Ms. Ella at the present. Using the Nursing Care Plan.

Defining Characteristics Nursing Diagnosis Outcome Identification Nursing Interventions Rationale Evaluation

Subjective: Feels dizzy every Fatigue and anxiety related to Long Term: after one Independent: assess the acknowledgement that After two weeks the client
morning upon waking up nauseated psychological factor of pregnancy that month the client will clients emotional living with fatigue has a lot of complaints
and experiencing fatigue. She also may affect her pregnancy if she cannot be able to practice Psychological is both especially in psychological
declared that she resigned from her
job two weeks ago and she fears
financial support issues.
Objective:
-weight is 120 lbs.
-FHB = 140 BPM
temperature is 36.4 degrees Celsius
pr: 80 BPM
RR : 25 counts per minute
blood pressure : 110/ 160
cope up im her situation.
Rationale: Anxiety develops in
pregnant women regardless of their
physical emotional or economic status
throughout the nine months of
pregnancy
various interventions in responsible to fatigue physically and and an emotional distress
fatigue management emotionally because of what happened
monitor the client's
challenging helps in to her and her partner. she
Short Term: After the nutritional intake for
coping the patient will worried about her status as
nursing intervention adequate energy
need properly balanced this may affect her
the client can cope up sources and metabolic
intake of fats pregnancy. after nursing
with comfort ease and requirements
carbohydrates proteins intervention the client
alertness.
encourage the direct vitamins and minerals might cope up sense of
to provide energy energy and relieve all her
client to take at this 8
resource emotional distress for her
hours of sleep at night
and frequent rest pregnancy.
promoting relaxation
periods during the day
before sleep and
encourage the client to providing for several
avoid standing for long hours of uninterrupted
periods and for a while sleep can contribute to
seated as much as energy restoration
possible
prolonged standing
Dependent: evaluate effectively reduced the
the blood supply to the
laboratory/diagnostic muscle resulting in the
test. acceleration the onset
of fatigue and cause
-blood pain in the muscles of
the legs bar and neck as
-hemoglobin
well as pooling of blood
-hematocrit in the legs and feet
 -BUN which lead to varicose
veins
-Oxygen saturation
changes in this
-blood typing
physiological measures
-Ag may be associated with
other measurement.

10. Discuss the psychological changes that Ms. Ella would experience during her pregnancy and how would it affect her considering that her live in partner has left her and
now that she has no job.
- In the case of Mrs. Ella One of the psychological encounters that she might experience especially during her situation would focus more on stress, anxiety and depression
considering that her husband left her and that she does not have a job. This situation may contribute to a unhealthy pregnancy because aside from the support she must have
she is also financially unstable as to how she can aid her pregnancy.
11. To perform Leopold’s Maneuver is part of prenatal visit. Based on her AOG can the nurse perform the maneuver? Discuss and support your answer.
- In her case Ella cannot yet advisable to perform a Leopold’s maneuver since her AOG is only about four weeks and five days. Leopold’s maneuver is preferably performed
after 24 weeks gestation when fetal outline can be already palpated.
12. What is the significance of Leopold’s maneuver? Discuss nursing responsibilities and each maneuver and findings for each maneuver.
- The Leopold maneuver is used to help nurses determine fetus presentation and position. the maneuver has four specific action that a nurse must perform. nurses use this
process along with the assessment of the maternal pelvis shape to determine if complication will occur during the delivery and if the patient will require a cesarian section.

The fundal grip - Face the woman and place your hands on the abdomen and palpate the upper part of the abdomen of the patient. Fetal head is hard and round and has the
ability to move independently and does not move with the trunk. While the buttocks are softer and they are not independent of the trunk, instead they move along with the
trunk.
The umbilical grip - Determination of the location of the fetal back is another important aspect. Second Leopold maneuver is done to determine the location of the back of
fetus. It is done by palpating the side of the abdomen with some deep pressure and fetal back will be felt smooth and firm.
The Pawlik’s grip- Third maneuver is done to determine which part of the fetus lying at the inlet of the abdomen. Using hands, grasp the lower portion of the abdomen
with the help of fingers of the right hand.
 The pelvic grip - The person doing maneuver should face the feet of the patient while doing so. This maneuver is done to determine the degree of flexion of the head of the
fetus.

13. How important is support person or family support towards a pregnant woman?

- In different aspect a very crucial rule that a partner or a family must perform with a pregnant member of the household because the support away mother can get from
these people can help her achieve a healthy pregnancy but with less stress and anxiety.

14. Discuss the significance of Prenatal visits. Plot the prenatal visits that the mother should follow.

- Prenatal visit is very important because it can help prevent complications and inform a mother like Ella about important steps they can take to protect her infant and
ensure a healthy pregnancy with regular prenatal care Ella can reduce the risk of pregnancy complication

15. The ability of a woman to accept her pregnancy depends on her partner, family and social influences. What does this statement mean to you as a Nursing student? Discuss.

- Lack of social support constitutes an important risk factor for maternal well-being during pregnancy and has adverse effects on pregnancy. It is very vital that pregnant
women get full social support from their family and partner during pregnancy otherwise it leads to pre-natal and post-natal depression. During pregnancy, emotional and
tangible support provided by the spouse and others is important to the expectant mother's mental well-being. Keep in mind that how well you cope with the social aspects of
pregnancy depends a lot on your personal expectations of the role of mother. Remember, ultimately you are in control of your life and that you have the power and ability
to make best and safe choices. These choices are good for you and for your children both. It is equally important to acknowledge your limitations otherwise it might
become a problem for you post-delivery. During your pregnancy you may form an image in your mind of what kind of parent you want to be when your baby is born.
You'll find that you receive an overwhelming amount of advice from well-meaning family and friends, some of whom are parents and some of whom are not.