#1)  Write down sample nursing diagnoses, interventions, and expected outcomes for the following client: Elaina, 27 years old, visits a prenatal clinic to confirm a positive pregnancy test. Elaina tells the nurse that she is not married and has no support system. She also states that she is making minimum wage at a restaurant with no health insurance and cannot afford prenatal care. She intends to keep the baby and would rather not tell her partner because “they don’t have that kind of a relationship.” Elaina asks the nurse “If I take good care of myself, why do I need prenatal care?” #2) Explain how the fetus is affected by tobacco use during pregnancy.  Keeping in mind the 2020 National Health Goals, what are some things you can do as a nurse to promote these goals and carry your ideas out into the community. #3) You are asked to perform an assessment of a pregnant  woman and her family. Prior to the assessment, devise a list of interview questions to use to assess the woman’s readiness for parenthood and current health status as well as her goals for the pregnancy. #4) For each of the following QSEN competencies write a list of nursing interventions for promoting fetal and maternal health related to each competency: Patient centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics. #5)  List the four major hormones produced in early pregnancy.  Describe what each one does.

#1 Sample nursing diagnoses, interventions, and expected outcomes for Elaina:

Nursing Diagnosis:
1. Ineffective individual coping related to lack of support system and financial constraints.
2. Risk for inadequate prenatal care related to lack of financial resources and health insurance.
3. Risk for non-disclosure of pregnancy to partner related to fear of relationship implications.

1. Assess Elaina’s emotional and psychological well-being, providing a safe and non-judgmental environment for her to express her concerns and fears.
2. Collaborate with social workers and community resources to explore options for financial assistance and health insurance coverage.
3. Provide education on the importance of prenatal care, including the benefits of regular check-ups and screenings.
4. Develop a care plan tailored to Elaina’s financial situation, including referrals to low-cost or free prenatal clinics and community resources for financial assistance.
5. Offer counseling and support for Elaina in discussing the pregnancy with her partner, emphasizing the importance of open communication and shared decision-making.

Expected Outcomes:
1. Elaina will demonstrate improved coping skills and a willingness to seek support from available resources.
2. Elaina will attend regular prenatal care visits and engage in activities that promote a healthy pregnancy.
3. Elaina will demonstrate effective communication with her partner regarding the pregnancy, fostering a supportive and collaborative relationship.

#2 Effects of tobacco use on the fetus during pregnancy:

Tobacco use during pregnancy has significant adverse effects on fetal development. Nicotine and other harmful chemicals in tobacco smoke cross the placenta and directly affect the fetus. These effects include:

1. Intrauterine growth restriction (IUGR): Tobacco smoke decreases the supply of oxygen and nutrients to the fetus, leading to restricted fetal growth and low birth weight.
2. Increased risk of preterm birth: Smoking during pregnancy increases the risk of premature labor and delivery, increasing the chances of neonatal complications.
3. Congenital malformations: Smoking increases the risk of fetal abnormalities, such as cleft lip and palate, cardiac defects, and limb defects.
4. Respiratory problems: Infants born to smoking mothers have a higher risk of developing respiratory problems, such as asthma, bronchitis, and pneumonia.
5. Increased risk of stillbirth and neonatal death: Tobacco use during pregnancy is associated with an increased risk of fetal death, stillbirth, and infant mortality.

As a nurse, promoting the 2020 National Health Goals can be accomplished by implementing the following strategies:

1. Conducting smoking cessation counseling and education: Provide information about the risks of tobacco use during pregnancy and offer support for smoking cessation. Implement evidence-based smoking cessation interventions, such as motivational interviewing and nicotine replacement therapy, to help pregnant individuals quit smoking.
2. Collaborating with community organizations: Partner with local organizations, such as public health departments and community clinics, to provide smoking cessation programs and resources for pregnant individuals. Utilize community resources to support pregnant individuals in their smoking cessation efforts.
3. Advocating for policy changes: Advocate for stronger tobacco control policies, such as increasing tobacco taxes, implementing smoke-free environments, and banning tobacco advertising, to reduce the prevalence of smoking during pregnancy. Engage in public health campaigns to raise awareness about the risks of smoking and promote healthy behaviors.
4. Providing prenatal education: Offer comprehensive prenatal education that includes information about the risks of tobacco use, the benefits of smoking cessation, and strategies for maintaining a healthy pregnancy. Develop educational materials and conduct group sessions to reach a larger audience.
5. Supporting research and evidence-based practice: Stay updated with the latest research on tobacco use during pregnancy and participate in continuing education to enhance nursing knowledge and skills in providing evidence-based care. Incorporate research findings into practice to ensure the provision of high-quality care to pregnant individuals.

#3 List of interview questions for assessing a pregnant woman’s readiness for parenthood and current health status as well as her goals for the pregnancy:

1. Can you tell me about your previous experiences with pregnancy and children? Are there any particular concerns or challenges you have faced in the past?
2. How do you feel about becoming a parent at this time in your life? What are your thoughts and expectations about parenthood?
3. Do you have any support systems in place to assist you during your pregnancy and after the baby is born? This could include family members, friends, or community resources.
4. How are you currently taking care of your physical and mental health? Are there any health conditions or factors that may impact your pregnancy?
5. Have you received any prenatal care yet? If not, what are some of the reasons why you have not sought care?
6. What are your goals for this pregnancy? Are there any specific outcomes or desires you have for yourself and your baby?
7. How do you envision your partner’s involvement in your pregnancy and parenting journey? Are there any challenges or concerns about involving them?
8. Are there any cultural or religious beliefs that are important to consider in the context of your pregnancy and parenting?
9. What are your expectations and hopes for the future beyond the pregnancy? How do you see yourself balancing your personal and professional life with parenting responsibilities?
10. Is there anything else you would like to share or discuss regarding your readiness for parenthood and your current health status?

These interview questions aim to gather information about the woman’s personal circumstances, emotional well-being, support systems, health status, and pregnancy goals. They can help the healthcare provider tailor care and support to meet the woman’s individual needs and preferences.