Nursing Management of the Pregnancy at Risk Discussion
Case Studies, 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) A. What is the management of care for the remainder of Maria’s pregnancy? B. If Maria’s lupus remains stable, will she require any modifications to standard care for her labor and delivery? C. How will the management of Maria’s pregnancy change if she develops a flare? 2. Nikki is a 17-year-old G1P0 at 33 weeks’ gestation. Nursing Management of the Pregnancy at Risk Discussion
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, “Please don’t take my baby away from me.” After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking “pot” and cigarettes. She relates that she also consumes 4 to 5 caffeinated beverages per day. (Learning Objective 10 and 12) A. How do cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake affect Nikki’s pregnancy? B. What possible affects are there to Nikki’s baby from the maternal ingestion of these substances? C. What is the nursing care you would provide for Nikki? Chapter 21, Nursing Management of Labor and Birth at Risk 1. Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC. (Learning Objective 9) A. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery. B. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this. C. Describe the management of care for a woman attempting a VBAC delivery. 2. Carol, age 17, is pregnant with her first child.
Her menstrual dates are accurate and her date of conception is limited to one possible day. Her physician gives her an EDC of March 28. Carol has gone past her due date and refuses to have her labor induced. Carol states, “My grandmother says that the baby will come when it is good and ready.” It is now April 14 and Carol is at 42 3/7 weeks’ gestation. She calls the office and reports that she is having a significant lower backache and she just passed “a glob of bloody mucus” from her vagina. (Learning Objective 5) A. Discuss the risks a prolonged pregnancy places on Carol. B. What risks are there for Carol’s unborn baby? C. Describe the nursing care required for women in labor with a prolonged pregnancy. Nursing Management of the Pregnancy at Risk Discussion