Complicated Client Case Study Provide rationale, citation and reference for all answers. Scenario 1.

Complicated Client Case Study

Provide rationale, citation and reference for all answers.

Scenario

1.     D.H. Is a 34 year old multigravida patient who wants to use the Basal Body Temperature method of the Fertility Awareness methods of birth control because she is "becoming older" and wants a less invasive method of birth control. D.H. desires more information about Basal Body Temperature method of birth control. Explain BBT method of birth control to include indications, reliability, risks, benefits, and how to use this method.

2.     D.H. at 37 years old comes to the clinic stating, "I think I may be pregnant. I haven't had a period in 10 weeks, my breasts are tingling, and I don't fit into my jeans." Based upon this information, what type of Signs of Pregnancy is this client experiencing?

3.     This is her fifth pregnancy. She has two children 8 and 3 at home both term deliveries (still living). Other pregnancies were spontaneous abortions. What is the GP and GTPAL based upon her maternal history?

4.      An ultrasound is done at the initial visit and confirms that the client is 7 weeks pregnant. What type of ultrasound was performed (using the number of weeks as a guide to determine the appropriate type)?

a.      What instructions would have been given to the client prior to the ultrasound being performed?

5.     The client states that her last period began on 2 March. Using Naegel's rule, what is the expected date of delivery?

6.     D.H. has an uneventful perinatal history. Then, at her 38 week prenatal appointment the nurse assesses the following: weight 176 lbs (increase of 10 lbs in one week); swelling in her hands, feet, and face; edema +2; blood pressure of 142/94 mmHg; pulse 88 bpm; edema +2; deep tendon reflexes +2; no clonus; proteinuria +2 (on urine dip); negative urine glucose; frontal headache with eases with acetaminophen. She states the light is too bright while shielding her eyes. What other questions should a nurse ask the patient at this time?

7.     What laboratory values should be considered at this time?

8.     What are the risk factors for preeclampsia (all of them)? Identify the risk factors that this patient has for preeclampsia?

9.     What are three possible complications with preeclampsia?

10. Write the priority physiologic nursing diagnosis for this client (what is the most important safety need)? Write a goal for this diagnosis.

11. D.H. is admitted to labor and delivery for a labor induction with pitocin. Describe the procedure for pitocin induction.

a.      What are the nursing responsibilities for safe administration of pitocin?

b.     What are three potential complications?

12. D.H. complains of increasing headache, proteinuria is +3, and DTR's are +3. Vital signs include Bp 154/94 mmHg, pulse 92. What is the primary concern based upon this assessment?

13. The physician orders magnesium sulfate infusion 4 gram bolus over 30 minutes, then 2 gm per hour. The pharmacy sends up an IV bag of 1 liter Lactated Ringers with 40 mg magnesium sulfate for a secondary line. Describe the procedure for magnesium sulfate infusion.

a.      What is the purpose for administering this medication?

b.     At what rate will the bolus be administered in mL/hr?

c.      Describe the adverse effects of magnesium sulfate administration.

d.     What are the nursing responsibilities for safe administration of MgSO4?

e.      

f.       

14. D.H. is being induced for labor for the past 2 hours and her cervix is 5 cm/ 80%/ 0 station. Membranes are ruptured for one hour of light yellow, colored amniotic fluid.

15. Review the stages of labor. What stage is D.H. in at this time based on the above information?