Family Centered Nursing OB Case Study - Answers

OB Case Study Mrs. Nguyen is a 23-year-old woman who presents to labor and delivery with complaints of increasing abdominal pain for the last two days. Upon meeting her, the nurse discovers that Mrs. Nguyen recently moved from China and has not received any prenatal care. She also speaks limited English and is accompanied by her significant other who speaks English fluently. (1a) What assessment data regarding Mrs. Nguyen’s medical and prenatal history should be obtained at this time? (1b) What lab work and tests should be ordered by the doctor? History should contain any chronic conditions, allergies, medications, social history, etc. Prenatal history should be obtained to assess pregnancy history, STD’s, complications with previous pregnancies, etc. Assess for prenatal care in China. Lab work: Blood type/screen, CBC w/differential, GBS, Rubella, Gonorrhea, Chlamydia, HIV panel, Hepatitis panel, CMP, urine analysis, UDS After interviewing Mrs. Nguyen and her husband, the nurse discovers that this is her third pregnancy. She has a 4-year-old daughter and the second pregnancy resulted in a fetal demise at 17 weeks gestation. (2) When calculating her gravida and para, which of the following is the correct? A. G2 P0 B. G2 P1 C. G3 P2 D. G3 P1 Mrs. Nguyen and her husband deny any issues with the current pregnancy and are unsure of the possible cause for the 17-week demise. Mrs. Nguyen appears very somber when asked about her last pregnancy. She does not seem very excited when talking about her current pregnancy either. (3a) What possible considerations should the nurse make at this time regarding Mrs. Nguyen’s attitude regarding her pregnancy? (3b) What should the nurse select as a priority nursing problem regarding Mrs. Nguyen’s mental current emotional status? (3c) What would the nurse’s goal be for the nursing problem selected? (3d) List 3 interventions and rationales for each to achieve the stated goal. (3a) The nurse should consider Mrs. Nguyen’s mood and emotional status. She has a history of a fetal demise and may be having a difficult time with her current pregnancy as a result. Her current emotional state may be affected by her memories of the fetal demise. (3b) Ineffective coping related to history of fetal loss as evidence by sadness and flat affect. (3c) Goals may include: The patient will remain safe during hospital stay; patient will verbalize 2 people she can talk to when she needs emotional assistance; patient will verbalize 3 coping techniques to overcome her sadness; patient will demonstrate appropriate bonding with her newborn. (3d) Interventions include: The nurse will administer Edinburgh Postpartum Depression Scale (evaluate for s/s of PPD); the nurse will educate the patient on techniques/activities to deal/cope with depression or sadness (will assist patient in coping better); the nurse will encourage the patient to verbalize and talk about her feelings (helps with self-control, improves relationship); encourage patient to take part in care of infant (supports emotional bonding with infant); encourage breastfeeding (decreases risk of postpartum depression, encourages bonding) A bedside ultrasound is performed and reveals an estimated gestational age of 37 5/7 weeks. The fetus is in the vertex position. Mrs. Nguyen is resting in bed clutching her abdomen, a stoic expression on her face. The nurse attaches the TOCO and ultrasound monitor. Next, she starts an IV and draws the ordered lab work. Mrs. Nguyen continues to occasionally clutch her abdomen every 3-5 minutes while the nurse notices contractions on the monitor. (4a) What are some cultural considerations for pain in the Chinese culture? (4b) As a nurse, how can you assist the patient in her pain management while being respectful to her cultural background? (4a) Chinese society values silence and women experiencing pain during labor and childbirth typically believe they will dishonor themselves and their families by wild or loud responses to pain. (4b) Do not draw attention to her pain, offer support, massage, pain relief strategies, education on pain management options, acupuncture, assess for cultural pain relief options. Respect! The following strip is displayed on the monitor. Answer the following questions regarding the EFM strip. (5a) What is the FHR variability? (5b) What is the baseline FHR? (5c) Are there accelerations (15x15)? (5d) Are there decelerations? If so, what kind? (5e) What is the frequency range of the contractions? (5f) How long do the contractions last (range)? (5a) Moderate (5b) 135 (5c) Yes (5d) No (5e) Every 1.5-3 minutes (5d) Approximately 40-65 seconds The doctor performs a cervical exam and reports that the patient is 5/90/-2. She attempted to rupture Mrs. Nguyen’s membranes but noted only a scant amount of amniotic fluid. She asked the patient if she had been leaking any fluid. Mrs. Nguyen did not appear to understand the doctor, her spouse translated, and it was discovered that Mrs. Nguyen had been leaking a few days. (6) What should the nurse monitor? A. The patient’s amniotic fluid B. The patient’s temperature C. The frequency of contractions D. The result of the urine analysis Mrs. Nguyen’s lab tests have resulted. The results are WBC – 14.5, Hemoglobin – 13, Hematocrit 40.8, Platelets – 150, RBC – 4.8. Results for her GBS, Hep B, Rubella, gonorrhea, and chlamydia are pending. The rapid HIV is negative. Her blood type is O-, UDS negative, and urinalysis unremarkable. (7) What can the nurse conclude about the lab results? (7) The WBC is elevated – possibly from infection or because of labor; Hgb, Hct & RBC are normal. Platelets are slightly low. GBS is unknown so should be treated as positive until results are established as negative. Blood type is Rh (-) which means patient may require Rhogam postpartum and has not received it her entire pregnancy since she has not received any prenatal care. Mrs. Nguyen has been in the unit in labor for 2 hours. Her vs are as follows: 99.5, HR 98, 118/76, 98% RA. Her present cervical exam is 7/100/-1. The monitor strip is below. (8a) What is the variability? (8b) Are there accelerations (15x15)? (8c) Decelerations? If so what kind? (8d) What is the frequency of her contractions? (8e) How long are the contractions lasting? (8f) How has Mrs. Nguyen’s condition changed over the past 2 hours? (8a) Minimal/moderate (8b) Yes (8c) No (8d) Approx. q2-3.5 min (8e) Approx. 40-70 seconds (8f) Temp has increased, HR increased slightly, variability is going to minimal, contractions spaced out and not as strong, she has dilated more. Mrs. Nguyen has agreed to an epidural and is resting comfortably with her spouse at her bedside. The doctor and nurse come in to assess Mrs. Nguyen. See below for the current strip shown on the monitor. (9) Which of the following interventions should be done first? A. Reposition Mrs. Nguyen to her left side B. Administer oxygen via nasal canula C. Administer a 1 L bolus of NS 0.9% D. Discontinue the oxytocin (10a) What is the baseline FHR in the strip below? (10b) What is the patient’s HR (range)? (10c) Are there any accelerations (15x15)? (10d) Are there any decelerations? (10a) 165 (10b) 105-140 (10c) No (10d) Yes. Variables The doctor performs another vaginal exam on Mrs. Nguyen at this time. She is now 7.5/100/-1. She is diaphoretic and shivering. Her vs are 102.7, HR 132, 122/85, and 99% RA. The doctor orders her Ampicillin 2 grams IV at this time and 650 mg Tylenol. (11) List possible risk factors that Mrs. Nguyen has for infection? (11) Prolonged ROM,? GBS status, no prenatal care An hour later, the nurse rushes into Mrs. Nguyen’s room. She is repositioned several times. The strip below is shown on the monitor. Cervical exam is 7.5/100/-1. Her vs are 101.2, HR 128, 130/86, and 99% RA. Which of the following interventions is the most appropriate at this time? A. Start Pitocin B. Administer oxygen via venti mask C. Administer a 1 L bolus of 5% Dextrose + LR D. Call the doctor Mrs. Nguyen is taken for a primary cesarean section. Her estimated blood loss during the procedure is 1500 mL. She is taken to recovery and returned to her postpartum room 45 minutes later. The nurse offers her to hold her baby skin to skin and initiate breastfeeding. Mrs. Nguyen waves her away and mumbles something. Appreciating what you know about Mrs. Nguyen thus far, complete the care plan below. It should contain 4 nursing problems, 1 specific goal for each problem, and a minimum of 3 interventions for each goal. Problem: Problem: Goal: Goal: Interventions: Interventions: Problem: Problem: Goal: Goal: Interventions: Interventions: