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Discussion: Care Plans for Pregnancy

The preparation for pregnancy can be frustrating for a woman, and the role of a nurse is to provide significant assistance to the patient in this process. In the first case study, a 25-year-old female comes to the office on 1-15-13 and states that her home pregnancy test was positive. The patient also reports that her last menstrual period (LMP) was on 12-1-12. These identifiers can be used by a clinician to calculate an estimated delivery date (EDD) with the help of Naegele’s Rule (Morgan & Cooper, 2018). To further support the suggested EDD, one can also perform an ultrasound (Tharpe, Farley, & Jordan, 2017). Schuiling and Likis (2017) state that home pregnancy tests are trustworthy as well, pointing out that the symptoms of nausea and breast changes are common signs of pregnancy. After establishing the date, the patient and her clinician should develop a care plan that includes all necessary procedures, treatments, and information that the future mother will need.

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Applying Naegele’s Rule, one can calculate that the patient’s EDD will come 9-8-13. According to this rule, one needs to use the woman’s first day of the LMP (December 1, 2012) as the basis of all measurements. Then, a clinician should add seven days and nine months, assuming that the patient’s menstrual cycle lasts for 28 days with 14 days of ovulation (Morgan & Cooper, 2018). As a result, the date September 8, 2013, is found; this calculation, however, may not be entirely accurate. According to Schuiling and Likis (2017), an ultrasound is another reliable way of determining when the baby is due. Overall, the patient’s LMP is a factor that contributes to one’s calculations.

The first visit should cover all essential information about the patient’s medical history, nutrition, physical examination, and diagnostics (Tharpe et al., 2017). The patient undergoes an interview with a nurse, during which they discuss the patient’s prenatal health, both its mental and physical aspects. For example, the pregnant woman’s current concerns, nutrition, obstetric and gynecologic health, family, environment, and physical abuse are covered during the interview (Centers for Disease and Control Prevention [CDC], 2018). During a physical examination, a nurse records the patient’s vital signs, height, weight, BMI, skin changes (hyperpigmentation, erythema, striae), and breast issues (enlargement, tenderness, vascularity) (Tharpe et al., 2017). Then, an abdominal examination and pelvic evaluation are performed as well. If the patient does not complete the initial assessment, she may encounter some unforeseen issues.

Initial diagnostics include blood tests (CBC, blood type and Rh factor, antibodies, HBsAg, HIV, syphilis, Rubella titer) and urine tests for culture, chlamydia, and gonorrhea (Schuiling & Likis, 2017). If the woman’s medical history has specific issues, they are assessed accordingly. Later, the patient undergoes a series of screening tests at different periods of gestation. These are maternal serum screening, nuchal translucency, noninvasive prenatal testing, quad screen, and anatomy ultrasound (Schuiling & Likis, 2017). Such tests allow one to document concerns about the fetus and the pregnancy’s progression. If they are missed, the patient may put her and her child’s well-being at risk.

In regards to the patient’s treatment, vital supplements with folic acid and iron are suggested to support the pregnancy. Moreover, a diet should be discussed with the patient; pregnant women should avoid some foods (for instance, unpasteurized milk and juices, prepackaged meals, or rare meat) (Schuiling & Likis, 2017). On the other hand, they should consume high-folate foods and choose products that appeal to them (CDC, 2018). The patient’s awareness of different screenings should be raised – the woman is offered various diagnostics for abnormalities and defects’ risks, and she should be educated to decide whether she needs these tests. Education also covers hygiene practices, infection prevention, proper cooking for dangerous foods, STIs, common symptoms, pain relief, and possible complications (Schuiling & Likis, 2017). The patient can also request some information about particular concerns – breastfeeding techniques, medication, mental health, environmental dangers, physical activity, or vaccination. Overall, the management approach should be holistic; the patient is allowed to make decisions, but a nurse should ensure that they are based on reliable data.

References

Centers for Disease and Control Prevention. (2018). During pregnancy. Web.

Morgan, J. A., & Cooper, D. B. (2018). Pregnancy, dating. Web.

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Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

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