The McGill Model of nursing practice was first outlined by A Canadian nurse educator

and health scientist named Moyra Allen (1921-1996). For most of her career, she held a faulty

appointment in the school of Nursing at McGill University. Then in the mid 70’s Allen outlined

a conceptual model of the approach to nursing espoused by McGill faculty of nursing and

launched abroad program of research to accumulate knowledge about nursing contribution in

relation to health outcomes. This framework according to Kravitz and Frey 1989 provides a

pragmatic organizing plan to explore, describe, and evaluate the full function of nursing: direct

the development of nursing curricula and generate questions for research in nursing practice and

health care. Over the years of its' formulation, the model was given different names of which

McGill Model of Nursing became the most familiar. Allen however was eager to find an

appropriate conceptual title. In 1985 she chose " A developmental Health Model Nursing as a

Continuous Inquiry" to reflect the model's developmental perspective on health and nursing.

Since then, McGill Model of Nursing has been used by various scientists to investigate nursing

practices in working with families (SlideShare, 2012).

According to Gotlieb & Rowat 1987, the salient features of this model are health, family,

collaboration and learning within the health, person, environment, and nursing paradigm. The

central goal of nursing according to this paradigm is to maintain, strengthen, and develop the

patient's health by actively engaging him or her in a learning process. Because health is a learned

phenomenon and the family is considered the primary socializer in this learning, the family is the

focus of nursing. Then nurse strives to structure a learning environment that enables the patient
to participate as fully as possible. The nurse and patient together set goals and, building on the

patient's strength and resources, devise means of achieving them (SlideShare, 2012).

This model is important because it focus on the family and its dynamics and influence a

nurse thinking in utilizing nursing process. It also allows nurses to gather data, critically think

and formulate researchable questions; analyse the data collected, draw conclusion, and make

appropriate recommendations and implement appropriate interventions when working with

families. More, it allows nurse to implement appropriate strategies and to evaluate the outcome.

The paradigm helps nurses to identify the strength and resources that are available in the

community (SlideShare, 2012).

According to the journal of Nursing education, nursing interventions can be described as

one of two ideas. First, any task that a nurse does to or for a patient and second, anything a nurse

does that leads directly to a patient outcome (Inhomecare, 2019).

These tasks may be general or specific and direct or indirect. Examples of areas of patient

care interventions include sleep pattern control, mobility therapy, compliance with diet, infection

control, alcohol abuse control, positioning therapy, bedbound care, energy conservation,

postpartum care. Nurses may work in specialized settings like ICU, oncology, which may require

knowledge of specific intervention unnecessary in other areas. Although every nurse may not be

familiar with every intervention, the concept remains universal across the field (Inhomecare,

2019).
 Nursing interventions are often confused with nursing assessments. Although both are

essential aspects of a nurse’s work, practice is distinct.

Assessment may be done by both nurses and physicians. They are how medical personnel

gain information about a patient’s symptoms and ailments. According to AMN (American

mobile nurses) Healthcare education services, there are four types of possible assessments first

one is comprehensive health assessments, which require a thorough review of a patient's health

second one is abbreviated assessments, which are done when lengthy evaluations are not

required, third one is Problem-focused assessments, which are designed to focus on a specific

ailment or medical issue and fourth one is assessment for special population, which are used for

medically significant groups of people, such as infants or the elderly (Inhomecare, 2019).

During assessment, nurses may gather information about patient health history, chief

complaints, present health status, condition of external body areas such as the skin,

neurological conditions, condition of internal systems such as cardiovascular, pulmonary, or

musculoskeletal, patient nutrition (Inhomecare, 2019).

Nursing interventions are informed by the results of nursing assessment. While the

ultimate gaol of an assessment is to decide on a course of treatment, an intervention in many

cases is the treatment. Nursing intervention also go beyond simply “fixing” a patient medically.

This action can include crisis therapy and stress control, terminal care and hospice, bereavement

support, meals on Wheels, communicating with nurses and physicians, coordinating nursing care

and conducting status reports, universal health precautions (Inhomecare, 2019).

 The Nursing Interventions Classification (NIC) system is designed to categorize and

describe every possible intervention a nurse might perform. This system is constantly used,

evaluated, and updated. Nursing Interventions Classification (NIC) describes several uses for the

system. They include Clinical documentation, standardized communication regarding care,

research on intervention effectiveness, productivity measurement, evaluations of competency,

curriculum design (Inhomecare, 2019).

A systematic approach to patient education requires including family members. Patient

teaching should be conducted with the family present, whether in the hospital, in an ambulatory

care setting, or at home. If family members will be the primary caregivers, educational materials

should be written to meet their unique needs. Most health-related educational materials for non-

professionals are written for patients. They describe what patients can do to cope with problems,

but not what the family member can do to help the patient. The family caregiver needs to know

everything that the patient does but, in addition, needs guidance in how to work with the patient.

Family caregivers usually have a need to plan ahead for problems that may occur. They also

need to learn the importance of paying attention to their own needs in order to be able to provide

the best possible care to the person with the illness and maintain a reasonable quality of life for

themselves (EuroMedInfo, n.d.).

Family members who are assuming caregiving responsibilities are often uninformed

about what to do. Increasing caregiver competence requires training family caregivers with the

skills they need to provide comprehensive care at home. It is helpful to plan with the patient and

the family when nurse will be providing teaching and what to expect. Here is a sample of how
nurse might prepare a patient for a teaching session Mrs. Green, I have set aside 15 minutes this

morning at about 10 a.m. I will be asking you and you husband to share some specific

information about your home and family situation that will better help us plan your care and your

discharge home. This message informs the patient about what the meeting will be about and lets

her know that she will be asked specific questions about her home and family situation.

In some situations, a questionnaire can be given ahead of time to collect initial data, which will

be discussed during the interview. When nurse do meet with the patient and family,

arrangements should be made to minimize interruptions and distractions. Interview should be

well planned for 15 minutes; well-used time accomplishes more toward reaching goals than an

hour with interruptions and lack of direction (EuroMedInfo, n.d.).

The COPE model, a system that focuses on helping family members become effective

problem solvers, is one means of approaching family teaching, especially when care needs may

seem overwhelming to family members. “C" stands for creativity. Creative strategies include

helping the family to overcome obstacles to carrying out medical management and to learn how

to generate alternatives. To be creative in a problem-solving sense, the problem solver learns

how to step back from a problem and view it from a new perspective in order to develop creative

solutions. For example, instead of consuming time and energy with food preparation, an elderly

parent could have food delivered by Meals on Wheels, or a friendly neighbor might be

approached to help drive the patient to medical appointments. “O" stands for optimism.

Optimism involves looking at the emotional aspects of the patient's caregiving needs, including

helping the family caregiver learn the interpersonal skills that communicate a can-do, optimistic

attitude. “P" is for planning-learning how to obtain expert information about what do in specific
situations. Planning for future problems is an important part of family education. Developing

contingency plans for possible events reduces uncertainty by specifying what will be done under

what circumstances. “E" stands for expert information. This part of the model focuses on

providing more background information to family members. Although it is important to start

teaching with „what" to do, as the family gains more confidence, teaching them the reasons why

they are doing specific care tasks will help them gain a greater sense of efficacy and control.

Expert information helps empower caregivers by enabling them to develop effective plans for

solving caregiving problems (EuroMedInfo, n.d.).

Mrs. B. is a 42-year-old multipara in the 35th week of gestation and she has 6 children at

home. When Mrs. B. didn’t experience any fetal movement from the last 24 hours. she became

worried and decided to go to the hospital with her husband. On arrival nurse note that Mrs. B.

and her husband seem very worried.

Client’s actual issue is decreased fetal movement and potential challenges are early

gestational age, decreased/increased amniotic fluid volume, maternal position (sitting or standing

versus lying), fetal position (anterior position of the fetal spine), anterior placenta, obesity,

maternal physical activity

Scenario didn’t confirm any medical diagnosis but probably client have decreased fetal

movement (DFM) because client didn’t experience any fetal movement in the last 24 hours. the

study suggests that there should at least be 6 fetal movements in the 2 hours. Decreased fetal

movement can be related to decreased placental perfusion and fetal acidemia and may indicate

asphyxia and IUGR. If compromised, the fetus decreases its oxygen requirements by decreasing
activity. Other factors can cause a decrease in fetal movements, such as maternal use of central

nervous system depressants, fetal sleep cycles, hydrocephalus, bilateral renal agenesis, and

bilateral hip dislocation (Perry, S.E., 2017).

Laboratory values or results are not indicated in the scenario but if six movements are not

felt within 2 hours further evaluation of maternal and fetal status is required, this would initially

include a nonstress test or biophysical profile may be done.

The nonstress test (NST) is the most widely applied technique for antepartum evaluation of

the fetus, although there is poor evidence that the use of NSTs decreases perinatal morbidity or

mortality. The basis for the NST is that the normal fetus produces characteristic heart rate

patterns in response to fetal movement. In a healthy fetus with an intact central nervous

304system, 85% of gross fetal body movements are associated with FHR accelerations. The

acceleration with movement response may be blunted by hypoxia, acidosis, medications

(analgesics, barbiturates, and β-blockers), fetal sleep, and some congenital anomalies (Perry,

S.E., 2017).

The NST can be performed easily and quickly in an outpatient setting; it is non-invasive and

has no known contraindications. Disadvantages center on the high rate of false-positive results

for atypical or abnormal tracings as a result of fetal sleep cycles, chronic tobacco smoking,

medications, and fetal immaturity. The test is slightly less sensitive in detecting fetal

compromise than the CST or BPP. No clinical contraindications exist for the NST, but results

may be inconclusive if gestation is 26 weeks or less (Perry, S.E., 2017).

 In this test Mrs. B needs to be an empty bladder and need to be seated in a reclining chair

(or in a semi-Fowler position) with a slight left tilt, to optimize uterine perfusion and avoid

supine hypotension. The FHR is recorded with a Doppler transducer, and a tocodynamometer

is applied to detect uterine contractions or fetal movements. The tracing is observed for signs

of fetal activity and a concurrent acceleration of FHR. If evidence of fetal movement is not

apparent on the strip, Mrs. B may be asked to depress a button on a handheld event marker

connected to the monitor when she feels fetal movement. The movement is then noted on the

tracing. Because almost all accelerations are accompanied by fetal movements, the

movements need not be recorded for the test to be considered reactive. The test usually is

completed in 20 minutes but should continue for up to 80 minutes if the response is not

normal (Perry, S.E., 2017).

Administering glucose to the mother or stimulating the abdomen to encourage fetal

movement is not recommended, as research has not proven either technique to be effective.

Only vibroacoustic stimulation has had some impact on stimulating fetal movement, although

it is not recommended because research has not concluded that this is safe or reliable (Perry,

S.E., 2017).

NST results are either normal, atypical, or abnormal. Fig. 1.1 and Table 1.3 list criteria

for the results for a term and a preterm fetus.

Fig. 1.1-Normal nonstress test. Fetal heart rate accelerations with fetal movement.

Fig 1.2- Atypical or Abnormal nonstress test (no fetal heart rate accelerations).
 Table1.3

ANTEPARTUM CLASSIFICATION: NONSTRESS TEST

PARAMETER NORMAL NST ATYPICAL NST ABNORMAL NST

• 110–160 bpm • 110–160 bpm • Bradycardia <100 bpm

Baseline
• >160 bpm • Tachycardia >160 for

<30 min >30 min

• Rising baseline • Erratic baseline

• 6–25 bpm • ≤ (absent or • ≤5 for ≥80 min

Variability
(moderate) minimal) for • ≥25 bpm >10 min

• ≤5 bpm (absent 40–80 min) • Sinusoidal

or minimal) for

<40 min

• None or • Variable • Variable decelerations

Decelerations
occasional decelerations >60 sec duration

variable <30 sec 30–60 sec • Late decelerations

duration

• 2 accelerations • ≤2 accelerations • ≤2 accelerations with

Accelerations
with the acme with the acme the acme of ≥15 bpm,
term fetus
of ≥15 bpm, of ≥15 bpm, lasting 15 sec in

lasting 15 sec lasting 15 sec in >80 min

<40 min of
PARAMETER NORMAL NST ATYPICAL NST ABNORMAL NST

testing 40–80 min

• ≥2 accelerations • ≤2 accelerations • ≤2 accelerations with

Preterm fetus
with the acme with the acme the acme of ≥10 bpm,
(<32
of ≥10 bpm, of ≧10 bpm, lasting 10 sec in
weeks)
lasting 10 sec lasting 10 sec in >80 min

<40 min of 40–80 min

testing

URGENT ACTION
Action Further assessment Further assessment
REQUIRED
is optional, required
An overall assessment of
based on the
the situation and
total clinical
further investigation
picture
with ultrasonography

or BPP is required.

Some situations will

require delivery.

bpm, beats per minute; BPP, biophysical profile; NST, nonstress test.

the normal result would be if there are two accelerations of fetal heart rate lasting

for 15 seconds that occur after movement. An abnormal result would be if there are no
fetal accelerations after a fetal movement, or there is no fetal movement (Perry, S.E.,

2017).

Contraction stress testing might also be done if the result in the nonstress test is

abnormal. The test is negative or normal if there are no decelerations in the fetal heart

rate during contractions. It is positive or abnormal if there is a late deceleration at the end

of a contraction and even after the contraction.

The contraction stress test (CST) or oxytocin challenge test (OCT) was the first

widely used electronic fetal assessment test. Its purpose is to evaluate the response of the

fetus to induced contractions and to thus identify the poor placental function. Uterine

contractions decrease uterine blood flow and placental perfusion. If this decrease is

sufficient to produce hypoxia in the fetus, a deceleration in FHR results, beginning at the

peak of the contraction and persisting after its conclusion (late deceleration). CSTs are

used much less frequently now, as uteroplacental function can be assessed using BPP or

vascular flow measurements (Perry, S.E., 2017).

In this test, Mrs. B will be placed in a semi-Fowler position or sit in a reclining

chair with a slight lateral tilt, to optimize uterine perfusion and avoid supine hypotension.

She is monitored electronically with the fetal ultrasound transducer and uterine

tocodynamometer. The tracing is observed for 10 to 20 minutes for baseline rate,

variability, and the possible occurrence of spontaneous contractions (Perry, S.E., 2017).
 The goal of a CST is to induce three contractions, each lasting 1 minute within

a10-minute period so that the fetal heart response to the contractions can be evaluated.

The CST can be done using maternal nipple stimulation or with an oxytocin infusion.

Negative results for a CST are associated with favorable results.

In the nipple-stimulated contraction test, massaging of the nipples causes a release

of oxytocin from the posterior pituitary. Mrs. B will be instructed to stimulate one nipple

through her clothing with the palmar surface of the fingers rapidly, but gently for 2

minutes, rest for 5 minutes, and repeat the cycles of massage and rest as necessary to

achieve the adequate uterine activity. Bilateral nipple stimulation may be considered

when unable to achieve contractions while stimulating only one nipple. When adequate

contractions or hyperstimulation occurs, stimulation should be stopped. Nipple

stimulation has a shorter testing time than oxytocin infusion, although if nipple

stimulation does not work, then oxytocin infusion should be considered (Perry, S.E.,

2017).

In the oxytocin-stimulated contraction test, the exogenous oxytocin can also be

used to stimulate uterine contractions. An intravenous (IV) infusion is started, and an

oxytocin infusion is initiated through a piggyback port into the tubing of the main IV

device. An infusion pump is used to ensure accurate dosage. The oxytocin infusion

usually is begun at 0.5 to 1.0 mU/minute and increases by 1.0 mU/minute at 15- to 30-

minute intervals until three uterine contractions of good quality are observed within 10-

minute period. Hyperstimulation is a risk, so slowly increasing the rate of oxytocin is

recommended (Perry, S.E., 2017).

 If a normal baseline FHR tracing and no late decelerations are observed with the

contractions, then findings will be considered negative (Fig. 1.4). A CST is positive if

late decelerations occur with more than 50% of the induced contractions (Fig. 1.5 and

Table 1.5)

Fig. 1.4- Negative contraction stress test (normal external fetal heart rate tracing)

Fig. 1.5- Negative contraction stress test (normal external fetal heart rate tracing)
 Table 1.5

INTERPRETATION OF THE CONTRACTION STRESS TEST

INTERPRETATION CLINICAL SIGNIFICANCE

Negative

No late decelerations, Reassurance that the fetus is likely to survive labour should it occur

with a minimum within 1 week; more frequent testing may be indicated by clinical

of three uterine situation

contractions

within a 10-min

period

Positive

Late decelerations Management lies between the use of other tools of fetal assessment,

occur with at least such as BPP, and termination of pregnancy; positive test result

50% or more indicates that the fetus is at increased risk for perinatal morbidity
INTERPRETATION CLINICAL SIGNIFICANCE

contractions, even and mortality; the physician may perform expeditious vaginal

if there are fewer birth after successful induction or may proceed directly to

than three Caesarean birth; a decision to intervene is determined by fetal

contractions in monitoring and presence of FHR reactivity

10 min

Atypical

Prolonged, variable, NST and CST should be repeated within 24 hr; if interpretable data

or late cannot be achieved, other methods of fetal assessment must be

decelerations used

occurring with

less than 50% of

the contractions

Equivocal–Tachysystole

Decelerations that Repeat test next day

INTERPRETATION CLINICAL SIGNIFICANCE

occur in the

presence of

contractions are

more frequent

than every 2 min

or last longer than

90 sec

Unsatisfactory

Failure to produce Repeat test next day

three contractions

within a 10-min

window or

inability to trace

the fetal heart rate

BPP, biophysical profile; CST, contraction stress test; FHR, fetal heart rate; NST, nonstress test.

After interpretation of the FHR pattern, the oxytocin infusion is discontinued, and

the maintenance IV solution is infused until the uterine activity has returned to the pre
stimulation level. If the CST is negative, the IV device is removed, and the fetal monitor

is disconnected. If the CST is positive, continued monitoring and further evaluation of

fetal well-being are indicated. While the use of CSTs has decreased because it has been

replaced by other technologies, one indication for the use of CST is to determine if a

fetus that has other abnormal testing results could tolerate a vaginal birth rather than

requiring a Caesarean birth. A fetus demonstrating an atypical or abnormal NST and a

positive CST is less likely to tolerate labour (Perry, S.E., 2017).

The biophysical profile combines fetal heart rate monitoring (nonstress test) and

fetal ultrasound to evaluate a baby's heart rate, breathing, movements, muscle tone, and

amniotic fluid level. If the fetus has a score of 8 to 10, it is doing well. If the score is 6,

this is considered suspicious. A score of 4 denotes that the fetus might be in jeopardy.

In fetal ultrasound, physiological parameters of the fetus that can be assessed with

ultrasound scanning include amniotic fluid volume (AFV), vascular waveforms from the

fetal circulation, heart motion, fetal breathing movements, fetal urine production, and

fetal limb and head movements. Assessment of these parameters, singly or in

combination, yields a fairly reliable picture of fetal well-being. The significance of these

findings is discussed in the following sections (Perry, S.E., 2017).

In biophysical Profile (BPP) Real-time ultrasound imaging enables detailed

assessment of the physical and physiological characteristics of the developing fetus to

such an extent that it is possible to examine the fetus in detail and to catalogue normal
and abnormal biophysical responses to stimuli. The biophysical profile (BPP) is a non-

invasive dynamic assessment of a fetus that is based on the assessment of acute and

chronic markers of fetal disease. The BPP is used to assess current fetal well-being by

observing fetal breathing movements, fetal movements, fetal tone, and AFV (Perry, S.E.,

2017).

The BPP may be considered a physical examination of the fetus, including the

determination of vital signs. The fetus responds to central hypoxia through alteration in

movement, muscle tone, breathing, and heart rate patterns. The presence of normal fetal

biophysical activities indicates that the central nervous system is functional; therefore, the

fetus is not hypoxemic. BPP variables and scoring are detailed in Tables 1.6 and 1.7. The

BPP is done with or without an NST. If done with the NST, the score is out of 10, and if

done without the NST, the score is out of 8 (Perry, S.E., 2017).

Table 1.6

SCORING THE BIOPHYSICAL PROFILE

 ABNORMAL
VARIABLES NORMAL (SCORE = 2)
(SCORE = 0)

Fetal breathing One or more episodes in 30 min, each Episodes absent or no episode

movements lasting ≥30 sec ≥30 sec in 30 min

Fetal movements At least three trunk or limb movements Fewer than three episodes of

in 30 min body or limb movements

in 30 min

Fetal tone At least one episode of active extension Absence of movement or

with return to flexion of fetal limb or slow extension/flexion

trunk; opening and closing of hand is

considered normal tone

Amniotic fluid index At least one cord and limb-free fluid No single pocket of fluid that

pocket that is 2 cm by 2 cm in two is 2 cm by 2 cm

measurements at right angles

Abnormal
Nonstress test—may or Normal
 ABNORMAL
VARIABLES NORMAL (SCORE = 2)
(SCORE = 0)

Atypical
may not be done

Table 1.7

BIOPHYSICAL PROFILE SCORE INTERPRETATION AND MANAGEMENT

SCORE INTERPRETATION MANAGEMENT

8–10 Normal; low risk for Repeat testing as required based on risk factors

chronic asphyxia

6 (normal fluid) Equivocal test Repeat testing within 24 hr

6 (abnormal fluid) Suspect chronic asphyxia Birth of term fetus. In fetus <34 weeks, intensive

surveillance may be used and delivery

considered
SCORE INTERPRETATION MANAGEMENT

<6 Abnormal; suspect chronic Deliver for fetal indications

asphyxia

The BPP is an evaluation of current fetal well-being. Fetal acidosis can be

diagnosed early with an abnormal NST and absent fetal breathing movements. A BPP

score of less than 6, or a score of 6 along with oligohydramnios, indicates that labour

should be induced (Table .7). The BPP identifies a pocket of amniotic fluid of less than

2 cm by 2 cm as oligohydramnios. Fetal infection in women whose membranes rupture

prematurely (at less than 37 weeks of gestation) can be diagnosed early by changes in

biophysical activities that precede the clinical signs of infection and indicate the necessity

for immediate birth. When the BPP score is normal and the risk of fetal death low,

intervention is indicated only for obstetrical or maternal factors (Perry, S.E., 2017).

Amniotic fluid volume assessment can also do, abnormalities are frequently

associated with fetal disorders. Subjective determinants of oligohydramnios (decreased

fluid) include the absence of fluid pockets in the uterine cavity and the impression of

crowding of fetal small parts. An objective criterion of decreased AFV is met if the

largest pocket of fluid measured in two perpendicular planes is less than 2 cm. Increased

amniotic fluid is called polyhydramnios or sometimes just hydramnios. Subjective

criteria for polyhydramnios include multiple large pockets of fluid, the impression of a

floating fetus, and free movement of fetal limbs. Hydramnios is usually defined as

pockets of amniotic fluid measuring more than 8 cm (Perry, S.E., 2017).

The total AFV can be evaluated through a method in which the depths (in

centimeters) of amniotic fluid in all four quadrants surrounding the maternal umbilicus

are totaled, resulting in an amniotic fluid index (AFI). A normal AFI is 10 cm or greater,

with the upper range of normal being around 25 cm. AFI values between 5 and 10 cm are

considered to be low normal, whereas an AFI of less than 5 cm indicates oligo-

hydramnios. With polyhydramnios the AFI would be above 25 cm. There is evidence that

the use of AFI, rather than pocket size, increase the rate of intervention without

improving outcomes (Perry, S.E., 2017).

Oligohydramnios is associated with rupture of the membranes and congenital

anomalies (such as renal agenesis), IUGR, and fetal distress in labour. Polyhydramnios is

associated with NTDs, obstruction of the fetal gastrointestinal tract, multiple fetuses, and

fetal hydrops (Perry, S.E., 2017).

Scenario didn’t mention history of client’s previous or current medication,

However, medications that include benzodiazepines, methadone, and other opioids can

cause transient suppression of fetal movement. Alcohol and cigarette smoking may also

cause decrease fetal movement.

 Drugs taken by a pregnant woman reach the fetus primarily by crossing the

placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's

growth and development. However, drugs that do not cross the placenta may still harm

the fetus by affecting the uterus or the placenta.

Drugs that a pregnant woman takes during pregnancy can affect the fetus in

several ways. They can act directly on the fetus, causing damage, abnormal

development (leading to birth defects), or death and can alter the function of the

placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the

supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a

baby that is underweight and underdeveloped. More, they can cause the muscles of the

uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply

or triggering preterm labour and delivery. Moreover, they can also affect the fetus

indirectly. For example, drugs that lower the mother's blood pressure may reduce blood

flow to the placenta and thus reduce the supply of oxygen and nutrients to the fetus

(MerckManual, 2021).

Fetal brain, kidney, and urogenital system malformations have been associated

with maternal cocaine ingestions. Heroin use in pregnancy frequently results in

intrauterine growth restriction. Studies have found a higher incidence of meconium

staining in infants born of mothers who used marijuana during pregnancy (MerckManual,

2021).

The scenario didn’t mention much about the client’s family income, social status,

physical environment, education, and social support network which could be the client’s
strength, but it does mention that her husband is with her in this crucial situation which

reflects that her husband cares about the client and the baby which is one of the important

client’s strengths and it also mentioned that she has six children at home which shows

that client have strong social support which is an important client’s strength.

Physical environments play a vital role in pregnancy as there could be unsafe soil

and water conditions and environmental exposure to pollutants, such as paint with lead

content. Many Indigenous communities have boil-water alerts to ensure that they are

drinking safe water. Another example is the consumption of mercury-contaminated fish,

which may pose health risks to a developing fetus (Perry, S.E., 2017).

Income and Social Status is the most important determinant of health and could

be the client’s strength because they influence on living conditions, level of education,

quality of diet, and extent of physical activity. A lower-income level is associated with an

increased risk for medical complications of pregnancy. A woman with a lower income

may not have as many support people to ask for assistance, to arrange for transportation

to appointments, or childcare so if has good social status and income it could be a major

strength of the client (Perry, S.E., 2017).

A woman's level of education can reflect her knowledge of the importance of

prenatal care and awareness of where to receive it. Having a higher education level

increases women's confidence in asking questions and making choices and has been

associated with fewer adverse outcomes in pregnancy and postpartum (Perry, S.E., 2017).
 Since the patient is 42 years old, she is in the Middle Adulthood stage according

to Eric Erickson's theory. During this stage, the patient is focused on caring for her

family. Generativity is developed at this stage when the patient is raising her children,

being productive at work, and becoming involved in community activities and

organizations.

During this stage, middle-aged adults begin contributing to the next generation,

often through childbirth and caring for others; they also engage in meaningful and

productive work which contributes positively to society. Those who do not master this

task may experience stagnation and feel as though they are not leaving a mark on the

world in a meaningful way; they may have little connection with others and little interest

in productivity and self-improvement (verywellmind, 2021).

Client’s actual nursing diagnosis will be Anxiety related to the threat of death of

fetus as evidenced by verbalization of concern to the fetal well-being and deficient

knowledge related to unfamiliarity with the condition of the fetus and potential nursing

diagnosis for client will be risk for impaired fetal gas exchange related to altered oxygen

supply or blood flow (Nurseslabs, 2019).

The client’s anxiety/fear related to the threat of death of fetus short-term goal will

be that the client should discuss fears regarding self, fetus, and future pregnancies,

recognizing healthy versus unhealthy fears and client should verbalize accurate

knowledge of the situation and long-term goal will be to demonstrate problem-solving

and use resources effectively and client will appear relaxed and report that anxiety is

reduced to a manageable level (Nurseslabs, 2019).

 The client’s deficient knowledge related to unfamiliarity with the condition of the

fetus short-term goal will be that the client will exhibit interest and participate in the

learning process and the client will verbalize, in simple terms, the pathophysiology and

implications of the clinical situation and long-term term goal will be to initiate necessary

lifestyle changes and participate in the treatment regimen (Nurseslabs, 2019).

The client’s risk for impaired fetal gas exchange related to altered oxygen supply

or blood flow short-term goal will be that the fetus will display FHR and beat-to-beat

variability within the normal limit and long-term goal will be that the fetus will be free of

adverse effects of hypoxia (Nurseslabs, 2021).

Nursing intervention for client’s anxiety/Fear related to the threat of death of fetus

as evidenced by verbalization of concern to the fetal well-being will be to identify the

client's perception of the threat represented by the situation and observe the client's

behavior because it will help in assessing and determining the client's level of anxiety and

next nurse should explain the situation to the client including procedures that will be

performed and what symptoms mean, with client and partner because this will increase

client’s and family’s knowledge about the situation and this information can help to

reduce fear and anxiety and it will also promote a sense of control over the situation.

More, nurse should recommend relaxing strategies such as deep breathing exercises,
prayer, and meditation to help alleviate anxiety and promote wellness for the client

(Nurseslabs, 2019).

Nursing intervention for deficient knowledge related to unfamiliarity with the

condition of the fetus will be to assess the client's level of knowledge of the situation as it

will help in assessing the client’s knowledge and learning need. Next, nurse should allow

the client to ask questions and verbalize misconceptions because it will provide

clarification of misconceptions, identification of problems, and opportunity to begin to

develop coping skills and moreover, explain the prescribed treatment and rationale for the

condition. Reinforce information provided by other healthcare providers because it will

provide information, clarify misconceptions, and may aid in reducing associated stress

(Nurseslabs, 2019).

Nursing intervention for risk for impaired fetal gas exchange related to altered

oxygen supply or blood flow will be first to assess FHR changes during a contraction,

noting decelerations and accelerations because it will help in detecting the severity of

hypoxia and possible cause. Next, nurse should urge the client to perform the counts in a

relaxed environment and a comfortable position, such as semi-Fowler's or side-lying to

alleviate anxiety and promote comfort). More, turn the client side to side as indicated as it

will helps in taking the pressure from the presenting part off the umbilical cord if the cord

is being compressed (Nurseslabs, 2021).

.
 Evaluation goal for anxiety/fear related to the threat of death of fetus as evidenced

by verbalization of concern to the fetal well-being is that the client will discuss fears

regarding self, fetus, and future pregnancies, recognizing healthy versus unhealthy fears

and after 4 hours of nursing intervention, the client will demonstrate relaxation strategies

every 1-2 hours by the end of the shift, and the client will appear relaxed and report that

anxiety is reduced to a manageable level after 8 hours or by the end of the shift

(Nurseslabs, 2019).

Evaluation goal for Deficient knowledge related to unfamiliarity with the

condition of the fetus is that after 4 hours of nursing intervention, the client will verbalize

her understanding of the disease process and treatment regimen and the client will also

demonstrate a willingness to cooperatively participate in the treatment regimen, after 8

hours of nursing interventions (Nurseslabs, 2019).

Evaluation goal for risk for impaired fetal gas exchange related to altered oxygen

supply or blood flow will be that the fetus able to display FHR and beat-to-beat

variability within a normal limit after 8 hours of nursing interventions and the fetus will

not display adverse effects of hypoxia after 3 days of nursing interventions (Nurseslabs,

2021).

Resources
EuroMedInfo, (n.d.). Strategies for teaching family members. Retrieved from

https://www.euromedinfo.eu/strategies-for-teaching-family-members.html/

Inhomecare. (2019). Nursing Intervention for home care. Retrieved from

https://www.inhomecare.com/what-is-nursing-intervention-guide-to-nurse-interventions/

MerckManual. (2021). Drug Use During Pregnancy. Retrieved from

https://www.merckmanuals.com/en-ca/home/women-s-health-issues/drug-use-during-

pregnancy/drug-use-during-pregnancy

Nurseslabs. (2021). Impaired Gas Exchange Nursing Care Plan. Retrieved from

https://nurseslabs.com/impaired-gas-exchange/

Nurselabs. (2019). Prenatal Haemorrhage Nursing Care Plans. Retrieved from

https://nurseslabs.com/7-prenatal-hemorrhage-nursing-care-plans/

Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., Wilson, D., Keenan-Lindsay, L. & Sams,

C.A. (2017). Maternal Child Nursing Care in Canada. (2nd edition.) Toronto, ON; Elsevier

Canada

SlideShare. (2012). McGill model of nursing practice. Retrieved from

https://www.slideshare.net/fironga/mc-gill-model-of-nursing-practice
Verywellmind. (2021). Erick Erickson’s Stage of Psychosocial Development. Retrieved from

https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-2795740