Case study on chapter 6 “Caring for the Woman Experiencing Complications During Pregnancy” of the FADavis book.
Print Name:________________________
Case Study: Christina Diaz
Scenario:
Christina Diaz is a 16-year-old primigravida who arrives at the prenatal clinic for her first prenatal visit. Christina’s last menstrual period was approximately16 weeks ago. During the initial history, Christina tells the nurse that she is feeling fat and unattractive. She states that she has noticed ugly stretch marks and awful color changes on her breasts and abdomen.
Critical Thinking Questions
1. What is the priority nursing diagnosis at this time?
2. What is the expected outcome associated with this diagnosis?
3. Describe the teaching/learning needs related to the scenario that correspond to the priority nursing diagnosis.
4. List interventions with rationales that correspond to the priority nursing diagnosis.
Case Study: Elizabeth Fong
Scenario:
Elizabeth Fong is a 37-year-old primigravida with a twin pregnancy at 30 weeks of gestation. She arrives at the prenatal clinic for her regular checkup. Elizabeth reports that during the past several days she has been experiencing low back pain, difficulty breathing, and the sensation that her abdomen has “expanded.” She complains of fatigue and difficulty finding a position of comfort while resting. Elizabeth states that the twins are active. Elizabeth’s fundal height measures 36 centimeters. The fetal heart rates are as follows: Twin A = 140 bpm; Twin B = 134 bpm.
Elizabeth’s laboratory data from 1 week ago reveal the following findings:
Hemoglobin: 9.2 g/dL.
Serum ferritin level: 10 mg /dL.
1-hour glucose challenge test: 130 mg/dL.
A sonogram performed during this visit shows a closed cervix, normal fetal growth, and excessive amniotic fluid.
Critical Thinking Questions
1. What is the priority nursing diagnosis at this time?
2. What are the expected outcomes associated with this diagnosis?
3. Describe the teaching/learning needs related to the scenario that correspond to the priority nursing diagnosis.
4. List interventions with rationales that correspond to the priority nursing diagnosis.
Davis Advantage for Maternal-Child Nursing Care, Third Edition.
Chapter 6
Caring for the Woman Experiencing Complications During Pregnancy
Copyright ©2022 F.A. Davis Company
Copyright ©2022 F.A. Davis Company
1
Ectopic Pregnancy
Fertilized egg implants outside the uterine cavity
Unilateral stabbing pain in lower quadrant
Ruptured ectopic pregnancy can lead to extreme blood loss, shock, and death
Risk factors for experiencing an ectopic pregnancy
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2
Diagnostic Tools
Transvaginal ultrasonography
Used to confirm intrauterine or tubal pregnancy
If ultrasound is inconclusive, serial BhCG will be performed
Pelvic examination to confirm mass
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3
Lab Values
Beta-human chorionic gonadotropin
Type
Needed in cases of rupture, ectopic, or for operative surgery
Rh
Determine need to Rhogam
Complete blood count
White blood count
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4
Management
Salpingectomy
Removal of fallopian tube
Salpingostomy
Incision into the fallopian tube to remove the pregnancy
Methotrexate
Chemotherapeutic drug and folic acid inhibitor that stops all rapid cell production
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5
Gestational Trophoblastic Disease
Hydatiform mole or molar pregnancy
Abnormal placental development that results in the production of fluid-filled grapelike clusters
Proliferation of trophoblastic tissue
Associated with loss of pregnancy
In rare cases, associated with the development of cancer
Copyright ©2022 F.A. Davis Company
6
Pathophysiology of Molar Pregnancy
Fertilization of an empty ovum
Complete mole
Trophoblastic proliferation and the absence of fetal parts
Incomplete mole
Coexistent fetus that has a triploid genotype and multiple abnormalities
Invasive mole
Invades myometrium layers of the fetus
Copyright ©2022 F.A. Davis Company
7
Signs and Symptoms of Molar Pregnancy
Absence of fetal heart sounds
Markedly elevated quantitative serum hCG
Very low levels of maternal serum α-fetoprotein
Vaginal bleeding that may be scant or profuse
May pass part
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