#1  A 35 year old G1P0 is 20 weeks gestation with a past medical history of hypertension.  Her pregnancy has been uneventful; however, at today’s appointment, her blood pressure was 150/100mmHg at first check and 15 minutes later was still 136/90 mmHg.  She is also complaining of light-headedness and palpitations. A.  What actions would you take as her nurse? B.  What change should this patient be encouraged to do? C.  What are the expected outcomes? #2.  The patient is a 17 year old female who arrives to the emergency department in active labor with a questionable past of obstetrical history.  She indicates that she has had no prenatal care, does not remember her last menstruation period, and is evasive if this is her first pregnancy.  Blood work indicates she is Rh negative. A.  What are some concerns you as her nurse should be prepared for? B.  What teaching does this patient need? C.  What are the expected outcomes for this patient? #3  A 15 year-old female has come to the urgent care complaining about nausea, vomiting, and feeling tired all the time.  Her complaints are vague, but the nurse is suspicious she may be pregnant when the girl mentions she is late for her period. A.  What nursing care will you provide to this young lady if she is pregnant. B.   What nursing diagnoses will apply to this situation? C.  What are some expected outcomes? #4 A woman in labor has been progressing well with minimal difficulties.  The nullipara woman has been working with her coach, progressing through the process.  The fetal monitor has indicated that the fetus is in stable condition.  Suddenly, the monitor alarm goes off and exam reveals a possible prolapsed cord. A.  What steps should you take as her nurse? B.  What care does the mother and infant need? C. How would you evaluate that your interventions were helpful? #5  Your patient is a petite 23-year-old G1P0 woman.  Prenatal assessment has determined that this woman will need a cesarean birth due to cephalopelvic disproportion. A.  What can this patient and you as the nurse do prenatally to ensure a safe delivery? B.  What potential risks and/or complications should the nurse be aware of and prepare for? C.  What postoperative care will this mother and/or infant need?

1. A 35-year-old G1P0 patient, at 20 weeks gestation, with a history of hypertension presents with elevated blood pressure and symptoms of light-headedness and palpitations. As the nurse, the following actions should be taken:

– Perform a thorough assessment, including vital signs, fetal heart rate monitoring, and a review of her medical history.
– Notify the healthcare provider immediately about the elevated blood pressure and symptoms.
– Monitor the patient closely for any signs of worsening hypertension, such as severe headache, visual changes, or epigastric pain.
– Consider initiating antihypertensive medication if blood pressure remains elevated and symptoms persist.
– Educate the patient about the importance of regular prenatal visits, adherence to prescribed medications, and lifestyle modifications to manage hypertension during pregnancy.
– Collaborate with the healthcare team to develop a care plan that includes regular blood pressure monitoring, fetal growth assessment, and close follow-up.

The patient should be encouraged to make the following changes:

– Follow up regularly with her healthcare provider to monitor blood pressure and fetal well-being.
– Take any prescribed antihypertensive medication as directed.
– Maintain a healthy lifestyle by following a balanced diet, engaging in regular physical activity, and avoiding smoking or excessive alcohol consumption.
– Monitor her blood pressure at home, as instructed by her healthcare provider.
– Report any concerning symptoms or changes in fetal movement to her healthcare provider immediately.

The expected outcomes for this patient include:

– Stabilization of blood pressure within the target range.
– Improvement in symptoms of light-headedness and palpitations.
– Normal fetal growth and well-being.
– Prevention of complications associated with hypertension during pregnancy, such as preeclampsia or fetal growth restriction.
– A healthy pregnancy and delivery.

2. A 17-year-old patient arrives at the emergency department in active labor with an uncertain obstetrical history, no prenatal care, and Rh-negative blood type. As the nurse, some concerns to be prepared for include:

– Limited knowledge about the patient’s background and obstetrical history, which could affect the management of labor and delivery.
– Potential risks associated with inadequate prenatal care, such as undiagnosed medical conditions or infections.
– The need for Rhogam administration due to the patient’s Rh negative blood type.
– Uncertainty regarding the patient’s understanding of the labor process and lack of preparation for childbirth.
– Psychosocial and emotional factors related to the patient’s age and potential lack of support or resources.

The patient requires teaching in the following areas:

– Explanation of the labor process, including stages of labor, pain management options, and expectations during delivery.
– Education regarding the importance of prenatal care, regular check-ups, and potential risks associated with inadequate care.
– Discussion about the benefits of Rhogam administration and the implications of Rh incompatibility for future pregnancies.
– Reinforcement of contraception options to prevent unintended pregnancies in the future.
– Referral to appropriate resources for social support, financial assistance, and ongoing healthcare.

The expected outcomes for this patient include:

– Safe delivery with minimal complications for both the mother and baby.
– Adequate postpartum follow-up to address any unresolved concerns or issues.
– Referral to appropriate community resources for ongoing support and healthcare needs.
– Increased knowledge and understanding of the importance of prenatal care and contraception.
– Improved awareness and engagement in self-care and healthy lifestyle choices.

3. A 15-year-old female presents to urgent care with complaints of nausea, vomiting, fatigue, and a missed period. As the nurse, the following nursing care should be provided if she is indeed pregnant:

– Perform a pregnancy test or coordinate a laboratory test to confirm the pregnancy.
– Provide emotional support and a non-judgmental environment for the patient to express her concerns and feelings.
– Assess the patient’s understanding of pregnancy and available resources.
– Educate the patient about prenatal care and the importance of seeking early and regular prenatal visits.
– Provide information on healthy practices during pregnancy, such as nutrition, exercise, and avoiding harmful substances.
– Assess the patient’s social support system and refer to appropriate resources if needed.
– Discuss potential options and resources for pregnancy and childbirth preparation, including childbirth education classes.
– Collaborate with the healthcare team to create a care plan tailored to the patient’s specific needs and circumstances.

The nursing diagnoses that may apply to this situation include:

– Risk for inadequate prenatal care related to late recognition of pregnancy and lack of knowledge.
– Fatigue related to pregnancy and possible complications.
– Nausea and vomiting related to pregnancy or other causes.
– Anxiety related to a potential unplanned pregnancy and its implications.

Some expected outcomes for this patient include:

– Early and regular prenatal care engagement.
– Reduced symptoms of nausea, vomiting, and fatigue.
– Improved understanding of prenatal care, healthy practices, and available resources.
– Development of a support network or involvement of appropriate support resources.
– Informed decision-making concerning the patient’s pregnancy options.