Chapter 20, Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations
1. Maria is a Hispanic 30-year-old who has not carried a pregnancy to term. She developed systemic lupus erythematosus (SLE), or lupus, when she was 25 years old. Maria is a G4P0 and has had three previous fetal demises. She is currently at 32 weeks’ gestation and has been asymptomatic during this pregnancy. Maria has been taking a daily dose of prednisone to suppress flare-ups. (Learning Objective 7)
- What is the management of care for the remainder of Mariaâ€™s pregnancy?
- If Mariaâ€™s lupus remains stable, will she require any modifications to standard care for her labor and delivery?
- How will the management of Mariaâ€™s pregnancy change if she develops a flare?
2. Nikki is a 17-year-old G1P0 at 33 weeks’ gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing have the distinct odor of marijuana and tobacco smoke. You directly ask Nikki if she has been taking any other drugs besides marijuana. Nikki is surprised by the question and denies it. When you explain that you can smell it in her hair and on her clothing, she starts to cry and says, â€œPlease donâ€™t take my baby away from me.â€ After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking â€œpotâ€ and cigarettes. She relates that she also consumes 4 to 5 caffeinated beverages per day. (Learning Objective 10 and 12)
- How do cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake affect Nikkiâ€™s pregnancy?
- What possible affects are there to Nikkiâ€™s baby from the maternal ingestion of these substances?
- What is the nursing care you would provide for Nikki?
Chapter 19, Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your â€œWhat to Expect with Twinsâ€ class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1 and 2)
- Why is Teresaâ€™s pregnancy considered a high-risk pregnancy?
- What are the potential pregnancy-related complications for Teresa?
- What are the potential risks to the babies?
2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mildâ€“moderate preeclampsia. At her clinic appointment today, Sarahâ€™s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)
- What needs to be included in a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome?
Chapter 12, Nursing Management During Pregnancy
1. Nancy, age 38, and her husband, Dan, age 37, arrive at a midwife clinic for an initial prenatal visit. They have been married for 10 years and trying to have a child for 3 years. Nancy completes the initial paperwork and the nurse notes the following obstetrical history: G3, T0, P0, A2, and L0. Nancy is approximately 8 weeks pregnant. (Learning Objectives 2, 3, and 4)
- What questions in the history are the highest priorities for the nurse to ask, given Nancyâ€™s obstetrical history? Why is this history important?
- What initial prenatal screening and testing would the nurse anticipate at this visit? Why?
- What prenatal screening and testing would the nurse anticipate for Nancy in the future related to her age? Why?
2. Carla is 36 weeks pregnant with her first child. She is in the office for her regular prenatal checkup. During this visit she complains of increasing heartburn, low back pain, constipation, and difficulty sleeping at night. Carla would like to know what she can do to get relief from these symptoms. (Learning Objectives 5 and 6)
- What needs to be included in the nursing management for Carlaâ€™s complaints?
- Now that Carla is nearing the end of her pregnancy, she has many questions regarding what to include as she starts preparing her birth plan. What information does Carla need to effectively plan for the birth of her baby?