You have finally reached the last activity to complete thismodule. Make certain you accomplish the activities below so you canproceed to the next module. For the final report, devise a writtenplan of care based on the patient case scenarios below. Submit yournursing care plan report in Final Evidence Forum.
Patient Scenario:
Molly Sandoval is a 25-year-old G2P1 at 37 weeks with a twingestation admitted to a birthing room in early labor. She states,if at all possible she wants to have a vaginal rather than acesarean birth.
CHIEF CONCERN:
Contractions began 8 hours ago; pattern has never becomeregular. Contractions are presently 5 to 20 minutes apart, about 30seconds in duration. She is having such back pain with contractionsshe asks to have something for pain relief. Membranes are notruptured.
FAMILY PROFILE:
The client is not employed; she volunteers days at center forcognitively challenged children, which her older son attends. Shealso volunteers as a waitress in her grandparent’s business atevenings. Her husband works as a garage mechanic. Finances are“tight.” The couple lives in a furnished apartment above a tavernthat her paternal grandparent’s own. Marriage is “shaky” due tostrain of finances, family disagreements, and “getting marriedbefore we knew each other very well.”
HISTORY OF PAST ILLNESSES:
She has chronic sinusitis from “allergies.” She had neardrowningaccident in neighbor’s pool at age 2 years and revived byparamedics with no apparent sequelae. She had tonsillectomy at age7 years. She was admitted at 30 weeks of present pregnancy forpreterm labor, was treated successfully with magnesium sulfate, anddischarged after 4 hours.
HISTORY OF FAMILY ILLNESSES:
Her maternal aunt has child with Down syndrome; Molly’s fatherdied of liver failure from alcoholism at age 45 years. Herhusband’s family has “many” people with peptic ulcers.
GYNECOLOGIC HISTORY:
Menarche was at 14 years; cycle duration: 28 days; duration ofmenstrual flow: 7 days.
She had history of secondary infertility for 2 years prior tothis pregnancy; pregnancy is conceived with in vitrofertilization.
OBSTETRIC HISTORY:
Molly had spontaneous miscarriage 4 years ago. She had previouspregnancy: boy, 8 lb 4 oz, vaginal delivery, born 5 years ago withDown syndrome. Her present pregnancy is conceived with in vitrofertilization. She attended prenatal care intermittently because offinances. Serum analysis is done for Down syndrome and reported asnegative. She had no preparation for labor class attended. “Notinterested in being brave during labor” is given as her reason.
DAY HISTORY:
Nutrition: 24-hour nutrition recall reveals diet high incarbohydrate and low in protein; prenatal vitamin not taken“because of finances”
Sleep: Sleeps 6 hours at night; bar downstairs is “too noisy”until after 3 am to sleep before that
Recreation: Does not participate in an active exercise program;walks “lots” every evening when she fills in as a waitress
REVIEW OF SYMPTOMS:
Reports lower back pains, constipation, urinary frequency, andswollen ankles
PHYSICAL EXAMINATION
General appearance: Alert, but distressed and exhaustedappearing obese, young adult pregnant female; height: 5 ft 3 in.;weight: 180 lb; blood pressure: 120/75 mmHg
HEENT: Within normal limits
Chest: Heart rate: 90 beats/min; no murmurs; lungs clear toauscultation; respiratory rate: 18 breaths/min
Abdomen: Fundal height: 45 cm; linea nigra present onabdomen
Fetus A: Fetal back palpated to be on left of maternal abdomen;head just above the symphysis pubis; fetal heart rate: 160beats/min
Fetus B: Fetal palpated under the spleen, buttocks on right sideof maternal abdomen; head not engaged; fetal heart rate: 140beats/min
Uterine contractions regular every 5 minutes, mild intensity
Pelvic examination: Diagonal conjugate measured at 12 cm; pubicarch wide; ischial diameter: 12 cm; coccyx movable; cervicaldilation: 4 cm; effacement: 20%; station: 0; Bishop score: 9;membranes intact
Extremities: Full range of motion; patellar tendon 2+; dependentedema 1+ below ankle on both sides
LABORATORY REPORTS:
Hemoglobin: 10.2 g/dl
Hematocrit: 31.8%
Urinalysis: Negative for protein and trace for glucose; specificgravity: 1.030
