Section B

Case Simulation 114

Name _______________________________Class/Group ________ Date _______
Group Members_____________________________________________________
INSTRUCTION. All questions apply to this case study. Your responses should be
brief and to the point. When asked to provide several answers, list them in order
of priority of significance. Do not assume information that is not provided. Please
print or write clearly. If your response is not legible, it will be marked as?, and
you will need to rewrite it.

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?
 Ask her LMP and 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?
 I will record as G0P0

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

 No more when she tells you she never been pregnant that means no
abortions no live births and no miscarriages. However, I would clarify
and ask her about abortions.
4. It is important to complete the intake interview. What categories will you
address with PM?
 Gather nursing history.
  Advise for prenatal check up

CASE STUDY PROGRESS

According to the clinic protocol, you obtain the following for her prenatal record:
CBC, blood type, urine for analysis (UA) ( protein, glucose, blood) vital sigs (VS),
height, and weight. Next, the nurse-midwife does a physical examination,
including 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 116/74mmHg
Heart rate 88beats/min
Respiratory rate 16breaths/min
Temperature 98.9F (37.2C)

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

 The blood pressure is a little low, I would check to make sure that I have
the correct blood pressure cuff and that it fits correctly. I would than
wait a minute and try again on the other arm.

6. P.M. Tells you that the date of her last menstrual period (LMP) was January
2nd. How would you calculate her due date? What is her due date?

 -You would use Naegele’s rule: You take the first day of the last
menstrual period, subtract three months, add seven days and a year.
That would make the due date October 9, 2020)
 What is the significance of a gynecoid pelvis?
  -This is the ideal pelvis for childbirth and pregnancy, because it is wider
and the inlet is rounded forward and back with a wide pubic arch this
makes it more spacious making it better suited for child birth.

7. What specimens are important to obtain when the pelvic examination is done?
 -After the pelvic examination you will need to obtain a pap smear,
gonorrhea culture and a herpes simplex culture.

8. What specimens are important to obtain when the pelvic examination is done?
 Specimens for Papanicolaou test (Pap) to screen for:
- cervical intraepithelial neoplasia,
-herpes simplex
-type 2 (genital herpes),
-and human papillomavirus (HPV; genital warts);
-cervical and vaginal smears for cytologic studies and diagnosis of
chlamydia, gonorrhea, and group B streptococcus infections.

CASE STUDY PROGRESS

Nursing interventions focus on monitoring the woman and fetus for growth and
development; detecting potential complications; and 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 psychological assessment is done to determine P.M.'s feelings and
attitudes regarding her pregnancy. ... A woman who is happy about
being pregnant is more likely to take care of herself better than a
woman who doesn't want to be pregnant.

10. PM asks you whether there are any foods that she should avoid while
pregnant. She lists some of her favourite foods. Which foods, if any, should she
avoid eating while pregnant?
 a. Hot dogs
b. Sushi
c. Yogurt
d. Deli meat
e. Cheddar cheese

- Sushi is not safe when you're expecting, either, because it may contain
illness-inducing parasites.
- Sushi that uses cooked fish and shellfish, such as crab, cooked prawns and
cooked eel, is fine to eat while you're pregnant. And vegetarian sushi,
which uses ingredients such as cooked egg or avocado, is also safe for you
to eat when you're pregnant.
- Hot dogs are safe to eat during pregnancy, as long as they are cooked over
160 degrees F. Any processed meat, such as hot dogs, salami, or cold cuts,
can potentially be contaminated with bacteria during the packaging stage.
- there's a small risk that harmful listeria bacteria may lurk in fresh-from-the-
deli-counter meats like turkey and ham.
- Dairy products, especially yogurt, are a great choice for pregnant women.
They help you meet increased protein and calcium needs. Probiotics may
also help reduce the risk of complications
- Hard cheeses are safe to eat during pregnancy, even if they're made with
unpasteurised milk. These include: cheddar
- The bacteria causing listeriosis, Listeria, is specifically dangerous as it can
cause spontaneous abortion. Since certain cheeses may be contaminated, it
is recommended to avoid their consumption during pregnancy.

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 what specific times during the pregnancy?
 Check vital signs including weight gain.
 Calculate due date based on last menstrual cycle and ultrasound exam.
 Calculate age of gestation
 Ask about health, including previous conditions, surgeries, or
pregnancies.
 Ask about family health and genetic history.
  Advise for Prenatal visits :
Before 28 weeks – monthly
28-36 weeks – every two weeks
36- Birth – weekly

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 ectopic pregnancy?” .Which of these are correct? (select all that apply)
a. Fullness and tenderness in her abdomen, near the ovaries
b. Nausea
c. Dark red or brown vaginal bleeding
d. Increased fatigue

 Light vaginal bleeding and pelvic pain.

 Upset stomach and vomiting.
 Sharp abdominal cramps.
 Pain on one side of your body.
 Dizziness or weakness.
 Pain in your shoulder, neck, or rectum.

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

14. Changes in the body caused by pregnancy includes relaxation of joints,

alteration to center of gravity, faintness, and discomforts. These changes lead
to problems with coordination and balance. In teaching P.M. about safety
during pregnancy, what will you include in your teaching?
Safety tips during pregnancy:
 Avoid fall
  Regular exercise during pregnancy helps improve your posture and
decreases discomfort and fall risk
 Strengthening Exercises:
 Core. Pelvic tilts are a great way to strengthen your abdominal and back.
 Legs. Squats strengthen the quadriceps, hamstrings, glutes, and calves.
 Hips. Hip extensions increase stability by strengthening the hip and
lower back muscles.
 Whole body. Swimming, walking, and indoor elliptical machines help
tone your entire body to assist in balance.
 Balance Exercises:
 Single-limb stance. This exercise involves standing on one leg for a
length of time (with a nearby chair or other object to hold for support).
This helps reinforce the feeling of your center of gravity over the ankles.
 Marching in place. Supported standing marches is good practice for
weight shifting.
 Sidestepping. Sidestepping strengthens your lateral balance.
 Prenatal yoga and Pilates. These improve your posture, core stability,
and balance.

15. P.M. asks, “Is vaginal exam done every visit? What is your response? Explain
your answer.
 The routine tests during pregnancy do not include an internal exam
(inside your vagina). If pregnancy is uncomplicated, it will only done an
internal exam after having gone into labour. This is done to check how
far the cervix has opened, which will tell how advanced a labour is.

CASE STUDY OUTCOME

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