Case study

Jean is 26 years old multigravida. She is seeing the doctor to confirm a positive
home pregnancy test. She is an employed accountant with health insurance. She is
single and had a visiting relationship with a young gentleman who is no longer in
the picture. She had an abortion 10 years ago, a twin pregnancy at 28 weeks 15
years ago. Twin female babies were prematurely at 28 weeks gestation and died 1
month after birth. She does not really want to have another abortion but is
concerned about not having a significant person to support her. She said she was
happy and scared to be pregnant. She had a menstrual flow X 4 days 1/25/13. She
had another menstrual flow lasting 1day 2/13/13. I did not realize that I could
become pregnant so quickly she stated. We were only intimate once.
1. What is Jeans GTPAL?
2. Identify the correct LMP last menstrual and calculate the EDD (expected date
of delivery)
3. What are the psychosocial issues that Jean is facing?
4. What is her gestational age today?
She complained of nasal stuffiness, epistaxis, nausea, vomiting, painless frequent
urination, leg cramps and increase in vaginal discharge. She is also seeking
information about how the pregnancy occurred and the two episodes of Menstrual
flow?
Nurse X was assigned to explain the process of ovulation, fertilization and
implantation. Nurse X was also assigned to explain the causes of her discomforts
and how she should cope with them.
Outline a teaching plan that covers all the information that Jean is seeking.
How should the nurse go about assessing her nutrition status? Why is it important
to assess her nutrition status?
What is the recommended weight gain during pregnancy? After the first trimester
how much weight should a pregnant female gain per week?
How many additional calories should Jean take?
It is important for pregnant patients to get sufficient calcium and iron. Identify foods
that are high in calcium and iron? How many cups of milk are recommended daily?

What is the usual schedule for prenatal visits for clients identified as low risk?
Should Jean be classified as low risk?

A multigravida female G7 T1 P2 A3 L3 arrived in labor. Her assessment was T 98.6F

P80 R20 BP 110/60. Cervical exam: 5cm/100/-1. Contractions every 5 minutes
lasting 80 seconds. She reported SROM (spontaneous rupture of membranes)
3/14/13 at 6 am.
What tests is required to determine whether membranes were ruptured?
What is the initial/first assessment to evaluate the fetus when membranes rupture?
What stage and phase of labor is this patient in?
The patient is requesting an epidural anesthesia. Should she get one?
When is the recommended time for epidural anesthesia?
Discuss the preparation for epidural anesthesia. What vital sign should be assessed
before and during epidural infusion?
After the epidural anesthesia the patients BP dropped to 80/60. The nurse turned
the patient to the side, called the anesthesiologist and received an order to give a
bolus of 200 ml IV fluids. What is the rationale for giving IV fluids and positioning?
What should the nurse do to evaluate the effectiveness of the interventions?
Review the fetal heart rate tracing? Identify the deceleration and the possible
cause. What initial nursing intervention is required?
1 hour later her cervix is 8 cm.
What cervical assessment and patient behaviors are associated with the transition
phase?
Two hours later the patients cervix was 10 cm dilated/100%/+1 station. What is the
first nursing action?
What stage of labor is the patient in?
What position would decrease the expulsive effort of contractions?
Finally the baby and the placenta were delivered. What stage of labor ends with the
delivery of the placenta?
The patient delivered a 9 lb baby over a midline 3 rd degree laceration.
The nurse looks at the umbilical cord stump. What is she assessing? When does the
4th stage begin and end?
How often should the nurse assess the patient during the first hour after delivery?

Describe the postpartum assessment using BUBLE HE.

What is the best position for assessing the episiotomy, lochia and hemorrhoids?
Review the patients history and indicate what she is at risk for during the postpartum period.
The patient saturated a pad in 15 minutes. What does this assessment suggest?
What should be the nurses first action?
Describe the physiological and psychological changes that the patient will
experience during the postpartum period and identify the problems the patient is at
risk for?
The nurse assessed the newborns Apgar score.
Explain how the Apgar score is assessed.
The newborn has to transition from intrauterine to extra uterine life.
Describes those changes and indicate the possible problems that the new born is at
risk for.
What assessments are made during the first 4 hours of life?
Describe the immediate and subsequent care of the newborn.
What is the legal requirement for a hospital stay for a vaginal delivery and a
cesarean section delivery?