CASE STUDY 114

SCENARIO

P. M comes to the obstetric ( OB ) clinic because she has missed two menstrual periods and
thinks she might be pregnant. She states she is nauseated, especially in the morning, so she
completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are
responsible for gathering information before she sees the physician.

1. What are the two most important questions to ask to determine possible pregnancy ?

- what was the last date of your menstrual period ?

- when did she have sexual intercourse ?

2. You ask whether she has ever been pregnant, and she tells you she has never been
pregnant. How would you record this information ?

- Since she said that she has never been pregnant, we would record that she is nulliparous.

3. What additional information would be needed to complete the TPAL record ?

- Gravida refers to the present pregnancy, para ( from TPAL ) refers to her past history. TPAL
is derived by asking about the number of term and preterm pregnancies, number of abortions
before 20 weeks gestation, and number of living children.
- The recording would be G1, Para 0000.

4. It is important to complete the intake interview. What categories will you address
with P.M ?

- In the initial interview we should ask P.. about present and past medical history, family
history, exposures and treatment of STD’ s, current medications taken, type of birth control
taken, consumption of alcohol or elicit drugs and her diet and nutrient intake.

CASE STUDY PROGRESS

According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood
type, urine for urinalysis ( UA ) ( protein, glucose, blood ), vital signs ( VS ), height, and
weight. Next, the nurse - midwife does a physical examination, including a pelvic exam and
confirms that P.M is pregnant. P.M has a gynecoid pelvis by measurement, and the fetus is at
approximately 6 weeks gestation.

CHART EXHIBIT

Vital signs
Blood pressure 116/74 mm Hg
Heart rate 88 beats/min
Respiratory rate 16 breaths/min
Temperature 98.9° F (37.2° C)

5. Do any of these vital signs cause concern ? what should you do ?

- There is no vital from the patient that is of much concern. The vital of a normal pregnant
woman in her weeks is expected to be as follows. The temperature should range between 37 -
37.8 degrees Celsius, which means my patients temperature is okay. Heart rate should be 80-
90 beats per minute, our patient having 88 is doing okay. Respiratory rate should be 14-20
breaths per minute, and therefore our patient with 16 breaths per minute is excellent. Finally,
the blood pressure of our patient is slightly below the normal of 116/74 mm Hg, but it is
nothing to cause any alarm. All the patient is required is to ensure that the blood pressure does
not fall anymore to reduce the risk of having low blood pressure. Therefore the patient should
take a lot of fish, beans, eggs, lentils, cereals, and grains rich in iron, leafy, tofu, lean red
meat, dark green vegetables, nuts and seeds.

6. P.M tells you that the date of her last menstrual period ( LMP ) was February 2. How
would you calculate her due date ? what is her due date ?

- I would use Naegele’s rule, which is based on the last period of my patient. I will use the
first day of her last period, which is on February 2. therefore I will add one year to February
2, which will be next year, February 2. Then, subtract three months to give me November 2.
After that, add seven days, which will provide me with November 9 of the same year. This
assumes that the pregnancy will last for 40 weeks. The due date of my PM is then estimated
to be November 9.

LMP February 2, 2021 Due Date : November 9, 2022

2 2 2021

LMP 15 2 2021
-3 +7 +1
12 9 2022
+1
13 9 2022 = February 9, 2022

7. What is the significance of a gynecoid pelvis ?

- Gynecoid Pelvis is one feature of a woman in the structure of her bone, which is the shape.
The primary importance is to protect a woman’s organs that are used for reproduction and
digestion and also in supporting hip joints.

8. What specimens are important to obtain when the pelvic examination is done ?

- Some of the specimens include vaginitis, foreign bodies, vaginal discharge, eversion, cysts,
and other lesions.

CASE STUDY PROGRESS

Nursing interventions focus on monitoring the women and fetus for growth and development;
detecting potential complications; teaching P.M. about nutrition; how to deal with common
discomforts of pregnancy, and activities of self - care.

9. A psychological assessment is done to determine P.M.’s feelings and attitudes

regarding her pregnancy. How do attitudes, beliefs, and feelings affect pregnancy ?

- A happy woman with being pregnant is most likely going to take good care of herself and
her unborn child than a woman who does not want the pregnancy. This will in turn lead to
giving birth to a healthy baby and fewer complications and accessible care for both of them.
A woman who believes that delivery is not a natural process is most likely going to give birth
through cesarean.

10. P.M. asks you whether there are any foods that she should avoid while pregnant. She
lists some of her favorite foods. Which foods, if any, should she avoid eating while she is
pregnant ? ( select all that apply. )

A. Hot dogs
B. Sushi
C. Yogurt
D. Deli meat
E. Cheddar cheese

11. As the nurse, you know that assessment and teaching are vital in the prenatal period
to ensure a positive outcome. What information is important to include at every visit
and at specific times during the pregnancy ?

- P.M should visit after every four weeks in the first 28 weeks. The tests should consist of
blood pressure, fetal movement, urinalysis, weight, and face, hand, and feet monitoring for
edema. The nurse should go over the usual things such as stress, readiness and diet. From then
the visits should be in every two weeks. The sessions should include questions on the birth
process, whether the patinet has a ready bag and preparations for the baby. After that, every
week, between 34-36 weeks. In the case of Fundal heights, the visits should be weekly
starting from week 18.

Most pregnant women can follow a schedule like this :

Weeks 4 to 28 of pregnancy. Go for one check up every 4 weeks ( once a month )

Weeks 28 to 41 of pregnancy. Go for one check up every 2 weeks ( twice a month )
Weeks 36 to 41 of pregnancy. Go for one check up every week ( once a week )

12. After her examination, P.M. states that she is worried because her sister had an ectopic
pregnancy and had to have surgery. She asks you, “ What are the signs of an ectopic
pregnancy ?” Which of these are correct ? ( Select all that apply. )

A. Fullness and tenderness in her abdomen, near the ovaries

B. Pain, either unilateral, bilateral, or diffuse over the abdomen
C. Nausea
D. Dark red of brown vaginal bleeding
E. Increased fatigue

13. P.M. asks the nurse about what should be reported to her doctor. List at least is of
the “danger signs of pregnancy.”

- I will tell P.M that she should immediately report to her doctor is she has been having
vaginal bleeding, convulsions/fits, severe headaches with blurred vision, fever and too weak
to get out of bed, severe abdominal pain, fast or difficult breathing, and swelling of fingers,
face and legs.

14. Changes in the body caused by pregnancy include relaxation of joints, alteration to
center of gravity, faintness, and discomforts. These changes can lead to problems with
coordination and balance. In teaching P.M. about safety during pregnancy, what will
you include in your teaching ?
- Much of the safety teaching one might provide to a pregnant woman are the same as the one
might provide to someone with limited mobility, such as removing loose rugs from the home,
taking extra care when using stairs, taking frequent breaks when doing strenuous physical
activity, wearing supportive shoes, and recognizing warning signs for when to contact a
doctor. Educating the pregnant woman about wearing a seat belt is almost important.

15. P.M. asks, “Is a vaginal exam done at every visit ?” What is your response ? explain
your answer ?

- Vaginal exams are not typically going to performed at every visit unless special
circumstances would require them. Vaginal exams are relatively invasive, and would not
provide much additional benefit to a healthy mother who is not presenting any new symptoms
indicating the need for a pelvic exam, Vaginal exam can also increase risks of infection to the
mother, so an exam will not be done until it is necessary.

CASE STUDY OUTCOME

P.M. makes an appointment for her next check up. You tell her that an ultrasound may be
done at about 8 to 12 weeks gestation to check fatal growth.