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 37weeks with a twin gestation admitted to a birthing room in earlylabor. She states, if at all possible she wants to have a vaginalrather than a cesarean birth.
CHIEF CONCERN: Contractions began 8 hours ago; pattern has neverbecome regular. Contractions are presently 5 to 20 minutes apart,about 30 seconds in duration. She is having such back pain withcontractions she asks to have something for pain relief. Membranesare not ruptured.
FAMILY PROFILE: The client is not employed; she volunteers daysat center for cognitively challenged children, which her older sonattends. She also volunteers as a waitress in her grandparent’sbusiness at evenings. Her husband works as a garage mechanic.Finances are “tight.” The couple lives in a furnished apartmentabove a tavern that her paternal grandparent’s own. Marriage is“shaky” due to strain of finances, family disagreements, and“getting married before we knew each other very well.
” HISTORY OF PAST ILLNESSES: She has chronic sinusitis from“allergies.” She had neardrowning accident in neighbor’s pool atage 2 years and revived by paramedics with no apparent sequelae.She had tonsillectomy at age 7 years. She was admitted at 30 weeksof present pregnancy for preterm labor, was treated successfullywith magnesium sulfate, and discharged after 4 hours.
HISTORY OF FAMILY ILLNESSES: Her maternal aunt has child withDown syndrome; Molly’s father died of liver failure from alcoholismat age 45 years. Her husband’s family has “many” people with pepticulcers. GYNECOLOGIC HISTORY: Menarche was at 14 years; cycleduration: 28 days; duration of menstrual flow: 7 days. She hadhistory of secondary infertility for 2 years prior to thispregnancy; pregnancy is conceived with in vitro fertilization.
OBSTETRIC HISTORY: Molly had spontaneous miscarriage 4 yearsago. She had previous pregnancy: boy, 8 lb 4 oz, vaginal delivery,born 5 years ago with Down syndrome. Her present pregnancy isconceived with in vitro fertilization. She attended prenatal careintermittently because of finances. Serum analysis is done for Downsyndrome and reported as negative. She had no preparation for laborclass attended. “Not interested in being brave during labor” isgiven as her reason.
DAY HISTORY: Nutrition: 24-hour nutrition recall reveals diethigh in carbohydrate and low in protein; prenatal vitamin not taken“because of finances” Sleep: Sleeps 6 hours at night; bardownstairs is “too noisy” until after 3 am to sleep before thatRecreation: 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, and swollen ankles
PHYSICAL EXAMINATION General appearance: Alert, but distressedand exhausted appearing 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 to auscultation; respiratory rate: 18 breaths/minAbdomen: Fundal height: 45 cm; linea nigra present on abdomen FetusA: Fetal back palpated to be on left of maternal abdomen; head justabove the symphysis pubis; fetal heart rate: 160 beats/min Fetus B:Fetal palpated under the spleen, buttocks on right side of maternalabdomen; head not engaged; fetal heart rate: 140 beats/min Uterinecontractions regular every 5 minutes, mild intensity Pelvicexamination: Diagonal conjugate measured at 12 cm; pubic arch wide;ischial diameter: 12 cm; coccyx movable; cervical dilation: 4 cm;effacement: 20%; station: 0; Bishop score: 9; membranes intactExtremities: 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
