NURSING MANAGEMENT DURING PREGNANCY

Beth (age 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).

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Definition of the Medical Diagnosis

Pregnancy is a psychosocial phenomenon that is usually characterized by the changes in biological as well as psychosocial adaptations which evolve generally in a healthy manner (Susan, Terri & Susan, 2009). However, some pregnant women may experience some problems or complications due to specific factors or characteristics. These can classify their conditions as high-risk and may negatively affect the mother/child evolution. The detection of this risk calls for the provision of appropriate and quality care by the nurses as well as the healthcare team. The gravid-puerperal period requires a multidisciplinary care because the women require minimal interventions. However, emergencies or life-threatening complications in some situations may occur and thus there is need to identify them effectively. A multi-disciplinary approach consisting of health professionals as well as local administrators is required to ensure that effective actions are performed to ensure that there is a risk-free and quality mother and child assistance (Gaucha, 2016).

The maternal as well as the neonatal morbidity data have been used to improve the technical as well as the scientific knowledge of the nursing practitioners who usually have direct participation during this period and thus ability to create quality strategies. Monitoring pregnant women during prenatal care, or during labor, delivery, or offering assistance to high-risk pregnant women in maternal ICUs are the role of nursing practitioners in obstetrics. This calls for a clinical preparation on the side of nursing practitioners so as to identify the real as well as the potential problems, manage the diagnoses correctly and plan and implement the care (Dennis & Hardy, 2016).

Common Signs and Symptoms

The common signs and symptoms of pregnancy are both physiological as well as psychosocial. Some of the physiological changes are increase in the size of breasts, increased blood circulation in the genitalia area, stretchmarks in the abdomen, absence of menstruation, pelvic pain/discomfort, intermittent nausea, swollen feet and ankles, vomiting, tiredness, weight gain, increased frequency of urination, and possible heartburn/indigestion. The psychosocial changes may include changes in her social life, dramatic body alterations, fear of raising the child alone without a father, and fear of giving birth or fear of pain during delivery (WHO, 2015).

Potential Complications

Pregnancy is a normal process in which the pregnant woman would be able to manage the problems and issues with the support of healthcare providers. However, there are some complications that might arise during pregnancy. Some of these complications include high blood pressure, preterm labor, gestational diabetes, preeclampsia, or a loss of pregnancy/miscarriage (ACOG, 2014).

Head to Toe Assessment

General: Steady movement, normal belly size at 24 weeks of pregnancy, impaired verbal communication due to anxiety.

Vital signs: Temperature, 98.6°F; heart rate, 99 bpm, blood pressure, 122/75 mm Hg; respiratory rate, 22 breaths/min

HEENT

Head : Excess dryness in hair.

Eyes: No eye pain, discharge or itchiness.

Ears: Normal external appearance.

Nose: Dry nasal mucosa with no purulent discharge.

Mouth/Throat: Dry oral mucosa without lesions, no sores or exudate. Healthy gums.

Breast changes : Normal breast changes. Colostrum can be expressed.

Respiratory : Clear to auscultation together with no coughs, rales, or rhonchi.

Cardiovascular: No history of syncope, murmur, palpitations or cyanosis.

Gastrointestinal: The client admits experiencing nausea and some instances.

Genitourinary : No vaginal odor, no swelling or redness observed.

Skin : No visible scars, lesions or rashes.

Abdominal : Fetal movements can be observed. No presence of scars, lesions or rashes.

Fundal height: Present at the upper margin of the umbicus and about three hand breadths from the symphysis pubis.

Abdominal girth: normal increase in abdominal girth. Normal liquor volume.

Musculoskeletal : The client reports instances of back pain. No history of fractures reported.

Neurologic : Client is a bit disoriented. Disturbed sleep patterns.

Diagnostic and Lab Studies Expected Outcomes

There are a number of physiological adaptations that develop throughout normal pregnancy. Some of these changes are confirmed through laboratory tests. However, some of the symptoms and tests may be easily be misinterpreted by some healthcare professional, especially those who are not experts or specialized in pregnancy related problems. The hs-cT nI concentration is one of the factors that is used to test pregnancy complications. For instance, higher values of hs-cT nI is an indicative factor of preeclampsia (ACOG, 2014). Furthermore, hyponatremia can occur in preeclampsia which is indicated by low levels of sodium and potassium. Cardiac evaluation to evaluate history of hypertension or cardiac diseases are also done. 3-hr glucose test is also done to screen for diabetes (Cervellin, Comelli , Bonfanti, Numeroso , & Lippi, 2019). NURSING MANAGEMENT DURING PREGNANCY