A POSTPARTAL WOMAN
Faye Chang is a 28-year-old, G4P3 woman you care for ina labordelivery-recovery room following birth of a 6 lb, 13 ozgirl.
CHIEF CONCERN:
“Pain. Sore breasts. Stomach cramps. Is it all right ifI get up and walk? Do you know I’m a vegetarian? Don’t want to seeany meat on a meal tray.”
HISTORY OF CHIEF CONCERN:
The client gave birth to a 6 lb 13 oz infant girl, 37weeks’ gestation, at 1:05 pm with no analgesia. She is concernednew baby is abnormally small because other children both were morethan 8 lb at birth.
FAMILY PROFILE:
The client was married when she was 20 years old, butmarriage ended after a trophoblast proliferation pregnancy. She iscurrently living with her boyfriend and two children in atwo-bedroom house; she works as a clerk in a mail-order cataloghouse. Her boyfriend works as a night club manager. Finances arereported as “okay.” Her boyfriend appeared supportive throughoutlabor. She voiced pleasure at sex and appearance of newchild.
HISTORY OF PAST ILLNESSES:
Faye had a venomous snake bite at age 15 years while ona camping trip. Antivenin was given immediately; there are nosequelae. Only hospitalization was for two previouschildbirths.
GYNECOLOGIC HISTORY:
Menarche was at age 17 years; cycle duration is 30 days.Menstrual flow duration is 7 days. Both she and sexual partner weretreated for chlamydia last year. It was relying on sexual partnerto use condoms as method of reproductive life planning prior tothis pregnancy.
OBSTETRIC HISTORY:
Faye had hydatidiform mole pregnancy 8 years ago,followed for 1 year with hCG levels. She never had any elevation inlevels. She had three pregnancies: boy, 8 lb 6 oz, vaginaldelivery, alive and well, 12 years ago; boy, 8 lb 8 oz, vaginaldelivery, alive and well, 10 years ago; girl, 6 lb 13 oz, vaginaldelivery, 2 hours ago, no anomalies at birth. This pregnancy wasnot intended but not unwelcome. She doesn’t drink alcohol but didsmoke “occasionally” during pregnancy. She took daily prenatalvitamin.
REVIEW OF SYSTEMS:
Essentially negative
PHYSICAL EXAMINATION:
General appearance: Distressed-appearing; young adultAsian woman
HEENT: Hair: unwashed; oily; some postpartal hair lossbeginning
Chest: Heart rate: 70 beats/min; no murmurs present;lungs: no adventitious sounds present; respiratory rate: 22breaths/min
Abdomen: Soft; fundal height 1 F under umbilicus andfirm and midline; linea nigra and striae present
Perineum: Edematous; mediolateral episiotomy lineintact; lochia: rubra, moderate, no clots
Extremities: Homans’ sign negative; no edema overtibia
Ms. Chang is diagnosed as having a usual postpartalcourse.
OPEN-ENDED QUESTIONS:
20. What if Ms. Chang tells you in the hospital that sheknows she had a perfect baby so should be happy but she can’t stopcrying? At what point would you suggest counseling forher?
21. What if Ms. Chang’s boyfriend tells you their newbaby looks nothing like him and asks you how soon he can request aDNA analysis to establish if he’s the father or not? How would youadvise him?
