Devise a HEALTH TEACHING PLAN based on the patient casescenario below.
A WOMAN WITH PLACENTA PREVIA
Lynn Holloman is a 19-year-old G3P0, 38-week pregnant, collegesophomore admitted by ambulance to the maternity service withpainless, profuse vaginal bleeding for the last hour.
CHIEF CONCERN:
“I’m bleeding bad.”
HISTORY OF CHIEF CONCERN:
The client was showering when she suddenly began “gushing”vaginal blood. She laid down and called the emergency number forhelp when it hadn’t stopped after 15 minutes. Blood pressure was95/60 mmHg, pulse at 90 beats/min in the ambulance. She was“soaked” with three towels during 20-minute transport period. Shehad a similar episode 1 week ago while at an amusement park. Theclient didn’t notify health care providers of that episode becausebleeding had stopped by the time she returned home (she states shethought labor was beginning but then stopped).
FAMILY PROFILE:
The client smokes half pack of cigarettes daily (couldn’t stopfor pregnancy because of pressure of school); she drank alcohol“occasionally” early in pregnancy before she realized she waspregnant; she has no recreational drug use. She lives in collegedormitory; she eats in college cafeteria. Her sexual partner was afellow student; they broke off relationship at 25 weeks ofpregnancy. The client states her parents are supportive and willhelp her raise child. She works as a TA in psychology department.Her job is not tiring; mostly correcting papers or other paperwork.
HISTORY OF PAST ILLNESSES:
She had chickenpox at age 4 years. She had ovarian cyst andright ovary removed at age 16 years. She “accidentally” swallowedan overdose of aspirin 2 years ago after a boyfriend left her.
HISTORY OF FAMILY ILLNESSES:
Her mother has chronic back pain. A paternal aunt hasdiverticulosis. A sister had an ectopic pregnancy 4 years ago.
GYNECOLOGIC HISTORY:
Menarche was at 9 years; cycle duration: 30 days; duration ofmenstrual flow: 5 days. She had moderate dysmenorrhea. She wastreated for herpes genitalis 1 year ago. There are no recentlesions noticed. She has been sexually active since age 15 years;usually insists on partner using condom but had stopped insistingbecause she and partner had established a monogamousrelationship.
OBSTETRIC HISTORY:
She had a therapeutic abortion at age 15 years and a spontaneousmiscarriage (12 weeks) at age 18 years. This pregnancy was planned;although since sexual partner left school 4 months ago, the clientadmits she is not as pleased with pregnancy as she was originally.She has attended hospital clinic for prenatal care since 4th monthand kept all appointments. Sonogram at 20 weeks reported adequatefetal growth but that placenta was low lying. She has few suppliespurchased for baby because she was waiting for semester to endbefore she did this.
REVIEW OF SYSTEMS:
Negative except for urinary tract infection at age 15 years
PHYSICAL EXAMINATION:
General appearance: Pale-appearing, white, pregnant female;height: 5 ft 8 in.; weight: 140 lb; blood pressure: 90/50 mmHg
HEENT: Two “shotty” lymph glands palpable on left posteriorcervical chain; throat slightly reddened; nose: mucous membraneswollen but not reddened
Chest: Heart rate at 86 beats/min; no murmurs; respiratory rate:24 breaths/min; no adventitious sounds on auscultation
Abdomen: Fundal height: 34 cm; linea nigra present on abdomen;fetus palpated to be in left anterior position; head not engaged;no uterine contractions noted; FHR: 90 beats/min
Pelvic examination: Deferred; vaginal bleeding, bright red inamount and profuse, still continuing
Extremities: Full range of motion in joints; patellar tendon2+
LABORATORY REPORTS:
Hemoglobin: 10.7 g/dl
Hematocrit: 37%
Urinalysis: Negative for protein and glucose; specific gravity:1.030
