Essentials of Maternity, Newborn, and Women’s Health Nursing

Chapter 11: Maternal Adaptation During Pregnancy

1. Jessica and Mike are new clients at your obstetrics office. You are asking them about the reason for their visit. Jessica says she thinks she is pregnant because she missed a period. Mike tells you Jessica is always nauseated in the morning and eats all the time the rest of the day. They have not been using birth control and have wanted to have children since they got married last summer. Jessica says her clothes are feeling tighter and her breasts seem tender. Mike says he has noticed that Jessica has been frequently getting up to go to the bathroom at night. (Learning Objectives 2 and 4)

a. What subjective symptoms have led Jessica and Mike to presume she is pregnant? What other conditions could be the cause of Jessica’s symptoms? How can a pregnancy be confirmed as probable? Diagnosed as positive?

a. The above question is not answered.

The subjective symptoms include nausea, breast tenderness and amenorrhea. Jessica missed her period and eats all the time. Eating all the time could be caused by food cravings.  No birth control,  requently getting up to go to the bathroom at night

Other conditions that could be the cause of Jessica’s symptoms include diabetes, anemia, gastrointestinal disorders, malnutrition, endocrine dysfunction and menopause. A blood test or urine test can diagnose a negative or positive result.

this is a probable sign of pregnancy not proof positive…. what give a false + HCG test?

What are the proof positive signs of pregnancy?

This is because the hormone hCG is present in both urine and blood.

Other conditions that could be the cause of Jessica’s symptoms are pancreatitis and anxiety disorders. The fact that she feels nauseated shows that she may be having pancreatitis. “Pancreatitis is an inflammation in your pancreas- an organ that secretes enzymes to help you digest your food” (Fairbrother et al, 2017). This may also have made her to have more foods cravings. She could be having anxiety disorders because these causes nausea. Her food cravings may have been caused by pica.

b. Discuss the nutritional needs of Jessica and her baby.

b. You did not include what she is to avoid.

Jessica will need to consume more legumes, nuts and meat. These will provide her body with iron and proteins. The key nutrients needed by the baby include iron, vitamin A, calcium, vitamin C, D, B6 and B12. The baby will need more calcium to strengthen bones and teeth. Some of the foods that can be taken include milk and cheese. Foods such as leafy greens and carrots will provide the vitamin A while vitamin C will be provided by tomatoes, broccoli, oranges and citrus fruit. Foods such as liver and whole grain cereals will help provide vitamin B6 and B12.

Vitamin C would help promote healthy gums and bones. It would also help the body of the pregnant mother to absorb iron. Iron helps increase the blood flow to ensure that adequate oxygen is supplied to the baby. “A pregnant woman should be getting 27 milligrams of iron and 1200 milligrams of calcium” (Oktay et al, 2016). These nutritional needs are met by ensuring that one eats a variety of recommended foods.

0. Beth (aged 18) is experiencing her first pregnancy and is now 24 weeks gestation. She tells you that she is “amazed by the changes that have happened to my body already.” Beth wants to understand what additional changes are going to occur to her “besides just getting a really huge belly.” Additionally, Beth relates to you that she is in her senior year of high school, is no longer involved with the baby’s father, and lives at home with her mother and 12-year-old brother. (Learning Objectives 3 and 5)

1. Explain to Beth (in terms she can understand) what general body adaptations she will experience throughout the remainder of her pregnancy.

Beth may experience swollen ankles and feet, pain in the abdomen area, leg cramps, dizziness and skin changes. “You might be experiencing pain on either one or both sides of your abdomen or hip area” (Fairbrother et al, 2017). This is caused by the straining and stretching of the ligaments that hold the uterus. She may also experience trouble sleeping because of the huge size of the belly and have frequent heartburn.

0. What psychosocial adaptations may Beth experience as a result of being a teenage, single mother living at home?

The psychological adaptions include high stress levels, lack of financial support and emotional disorders. She may also experience pain during the delivery, fears of giving birth, social life changes and dramatic body alterations. She may also experience fears of raising the baby without the help of the father. The father would be able to provide financial and emotional support if he was available.

REFERENCES

This reference has nothing to do with the content of these case studies.

Fairbrother, N., Young, A. H., Zhang, A., Janssen, P., & Antony, M. M. (2017). The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy. Archives of women’s mental health, 20(2), 311-319.

Essentials of Maternity, Newborn, and Women’s Health Nursing

Chapter 13: Labor and Birth Process

 Emily, age 32, has an obstetrical history of G1, T0, P0, A0, L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.

The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.

Ten minutes after the vaginal exam by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)

a. What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?

The questions include asking whether she is in pain, specifically whether or not she has low back pain. The nurse might also ask whether there is vaginal bleeding. The prenatal information would be the intensity and frequency of contractions.

Other questions:

When did the contractions begin?

Where do you feel the pain.. back or belly?

Does rest or drinking fluid help the pain?

Fetal movements?

b. Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? 

b. Did not develop one part of this question.

If the cervix is 3 cm dilated, 40 % effaced, Emily is in active labor. During phase 1, the cervix begs to dilate and continues to thin for the delivery. “Vitals are stable and FHT are reassuring meaning the fetus is not in any distress” (Oktay et al, 2016). The psychological changes include exhaustion, anxiety and fatigue while the physiological changes include increase in breathing and blood sugar. The appropriate activities would be to have Emily walk around to help in moving labor. Emily can participate in activities that involve walking.

c. Describe the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants.”

The nursing interventions are to assess the FHR and determine the color and odor of amniotic fluid in case the membranes ruptured. Vital signs should be assessed and nearness to birth should also be determined by evaluating cervical dilation and contractions.

Note the time of ROM

Notify HCP

2. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)

1. Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.

The cause of slow labor progress is the Passenger. The malposition of fetus causes it.

You have to identify the fetal positon that causes back pain and slow progress.

“The fetus is the ‘passenger travelling down the birth canal” (Subramaniam et al, 2019). The low progress may be as a result of the fetal head being too large in addition to the mispositioning. There might be exertion of pressure on the mother’s sacral backbone which causes the back pain and poor cervical dilatation.

0. What strategies may the nurse implement to assist Diane in progressing in her labor?

The strategies are:

a. Telling her to squat

b. Asking her to sit on the birth ball

c. Use of the miles circuit technique

d. Conducting abdominal lift

e. Asking Diane to balance on knees and hands on a bed to help adjust fetal position.

It is good to encourage Diane that she will be able to bear the pain of delivery. Since she has attained full dilation, she may give birth soon.  Incorrect she is at 3cms.. a log way to go

Diane should also remind on the birth plan.

REFERENCES

Oktay, K., Bedoschi, G., Pacheco, F., Turan, V., & Emirdar, V. (2016). First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. American journal of obstetrics and gynecology, 214(1), 94-e1.

Subramaniam, A., Tita, A. T., & Rouse, D. J. (2019). Obstetric Management of Labor and Vaginal Delivery. Chestnut’s Obstetric Anesthesia E-Book, 393.