Case Study 114
Name: Maasin, Jonah Rosalie A. Class/Group: BSN21, GRP 3 Date _________
INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and
to the point. When asked to provide several answers, list them in order of priority or significance.
Do not assume information that is not provided. Please print or write clearly. If your response is
not legible, it will be marked as? and you will need to rewrite it.
CHAPTER 11 : MATERNAL AND OBSTETRIC DISORDERS CASE STUDY 114
SCENARIO
P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she
might be pregnant. She states she is nauseated, especially in the morning, so she completed a home
pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering
information before she sees the physician.
1. What are the two most important questions to ask to determine possible pregnancy?
I would ask the patient of her LMP (last menstrual period) and also ask the patient when did she
have sexual intercourse.
2. You ask whether she has ever been pregnant, and she tells you she has never been pregnant.
How would you record this information?
We will record that P.M. is nulliparous and / or I will use the TPAL system to record her pregnancy
history information.
G,0 T0, P0, A0, L0, M0
3. What additional information would be needed to complete the TPAL record?
Gravida refers to the current pregnancy, while para (from TPAL) refers to her previous history.
TPAL is calculated by inquiring about the number of term and preterm pregnancies, abortions before 20
weeks' gestation, and living children. G1, para 0000 would be the recorded.
4. It is important to complete the intake interview. What categories will you address with P.M.?
In the initial intake interview we should ask P.M. about; present and past medical history, family
history, exposures and treatment of STD’s, current medications taken, type of birth control taken,
consumption of alcohol or elicit drugs and her diet and nutrient intake.
CASE STUDY PROGRESS
According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for
urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the nurse-midwife does
a physical examination, including a pelvic exam and confirms that P.M. is pregnant. P.M. has a gynecoid
pelvis by measurement, and the fetus is at approximately 6 weeks' gestation.
■ CHART/EXHIBIT
Vital Signs
Blood pressure 116/74 mm Hg
Heart rate 88 beats/min
Respiratory rate 16 breaths/min
Temperature 98.9° F (37.2° C)
5. Do any of these vital signs cause concern? What should you do?
The blood pressure is a little low, so I'd double-check that I'm using the correct blood pressure cuff
and that it fits properly. I'd then wait a minute before trying on the other arm.
6. P.M. tells you that the date of her last menstrual period (LMP) was February 2.
How would you calculate her due date? What is her due date?
we would use Naegele’s rule: You take the first day of the last menstrual period, subtract three
months, add seven days and a year. That would make the due date October 9, 2021.
7. What is the significance of a gynecoid pelvis?
This is the ideal pelvis for childbirth and pregnancy because it is wider, the entrance is rounded in
front and behind with a wide pubic arch, which makes it more spacious making it more suitable for
childbirth.
8. What specimens are important to obtain when the pelvic examination is done?
After the pelvic examination, you will need to get a Pap smear,
gonorrhea culture and herpes simplex culture.
CASE STUDY PROGRESS
Nursing interventions focus on monitoring the woman and fetus for growth and development; detecting
potential complications; and teaching P.M. about nutrition, how to deal with common discomforts of
pregnancy, and activities of self-care.
9. A psychological assessment is done to determine P.M.'s feelings and attitudes regarding her
pregnancy. How do attitudes, beliefs, and feelings affect pregnancy?
Pregnancy is always associated with changes in psychological functioning of pregnant women. It is
usually associated with ambivalence, frequent mood changes, varying from anxiety, fatigue, exhaustion,
sleepiness, depressive reactions to excitement. How a woman adjusts to a pregnancy depends a great
deal on physochological aspects, such as the environment in which she was raised, the messages about
pregnancy her family communicated to her as a child, the society and culture in which she lives as an adult.
(Silveira, Ertel, Dole, 2015, p. 203)
10. P.M. asks you whether there are any foods that she should avoid while pregnant. She lists some
of her favorite foods. Which foods, if any, should she avoid eating while she is pregnant? (Select all
that apply.)
a. Hot dogs
b. Sushi
c. Yogurt
d. Deli meat
e. Cheddar cheese
11. As the nurse, you know that assessment and teaching are vital in the prenatal period to ensure
a positive outcome. What information is important to include at every visit and at specific times
during the pregnancy?
During the health visit, it is important to instruct P.M. on self-care: breast health, per semester,
perineal hygiene, exercise, nutrition, sleep and body changes. In addition,should be educated to
understand the development and needs of the fetus every time she sees a doctor. It is very important to
educate her about teratogens and when they are the most harmful, which is 2 weeks to 3 months later.
12. After her examination, P.M. states that she is worried because her sister had an ectopic
pregnancy and had to have surgery. She asks you, “What are the signs of an ectopic pregnancy?”
Which of these are correct? (Select all that apply.)
a. Fullness and tenderness in her abdomen, near the ovaries
b. Pain, either unilateral, bilateral, or diffuse over the abdomen
c. Nausea
d. Dark red or brown vaginal bleeding
e. Increased fatigue
13. P.M. asks the nurse about what should be reported to her doctor. List at least six of the “danger
signs of pregnancy.”
1. severe vaginal bleeding
2. convulsions
3. severe headache with blurred vision,
4. severe abdominal pain
5. fast or difficulty in breathing
6. reduced fetal movement,
14. Changes in the body caused by pregnancy include relaxation of joints, alteration to center of
gravity, faintness, and discomforts. These changes can lead to problems with coordination and
balance. In teaching P.M. about safety during pregnancy, what will you include in your teaching?
I would include instruction on orthostatic hypotension and the importance of taking her time
transitioning from a sitting to a standing position. She should take her time standing up and getting her
body used to standing before starting to walk. I would also advise her to be aware of her surroundings.
15. P.M. asks, “Is a vaginal exam done at every visit?” What is your response? Explain your answer.
I will tell P.M. that after the first vaginal exam, unless there are
complications, the next vaginal exam will have to wait until about 36 weeks. At that time, she will have a
vaginal exam to check for changes in your cervix.
CASE STUDY OUTCOME
P.M. makes an appointment for her next checkup. You tell her that an ultrasound may be done at about 8
to 12 weeks' gestation to check fetal growth.
