Prenatal Assessment and Care Plan for a 37-Year-Old Pregnant Woman with Chronic Hypertension and Previous Obstetric History

Prenatal Assessment and Care Plan for a 37-Year-Old Pregnant Woman with Chronic Hypertension and Previous Obstetric History

Considerations for Caring for Clients with Complex Social Histories

A client with a history of depression, drug addiction, domestic violence, and STDs, like Elizabeth Jones, requires nurses to handle the issue with empathy, nonjudgment, and a trauma-informed attitude (Karam et al., 2021).   Domestic abuse can create significant physical and mental health risks that may persist. Given the fact that during pregnancy, the clients can use substances to harm fetal development, nurses must instruct a client about risks but should not stigmatize the client. The suffering of the fetus should not be left to chance; therefore, close monitoring and appropriate treatment of sexually transmitted infections like human papillomavirus (HPV) is needed to prevent the transmission to the fetus. Pregnancy, occasionally accompanied by mood depression, can affect both the pregnant mother and the developing fetus, and therefore, nurses need to carry out quality emotional support, counseling, and referral services for psychotherapists when necessary.

Self-Awareness and Provision of Unbiased Care

As health care providers, nurses must keep on self-reflecting to know and address any personal prejudices, attitudes, or thoughts that can significantly compromise the care they provide for those from very different socio-cultural backgrounds. A counselor must face every client with an unbiased mindset so that he/she may offer non-judgmental and supportive care designed to establish a personalized connection and fulfill the client’s specific needs. Moreover, by developing the ability to evaluate themselves and acting on cultural humility, nurses will provide culturally sensitive, knowledgeable, and low-barrier care to individuals, taking into account their clients’ particular circumstances.

Potential Concerns During Pregnancy, Labor, and Birth

Elizabeth Jones’ medical history presents several potential concerns during her pregnancy, labor, and birth. Her chronic hypertension puts her at a high risk of developing preeclampsia, which is caused when there is elevated blood pressure coupled with proteins in the urine. Monitoring the patient’s blood pressure regularly through antenatal care is necessary to identify and manage complications quickly (CDC, 2022). Consequently, the history of her cesarean section may enhance the risks for placenta abnormalities or uterine rupture in her later pregnancies, spurring a required evaluation and well-thought-out plans for the delivery mode.

Moreover, Elizabeth’s family history of insulin-dependent (diabetes mellitus), hypertension, heart disease, and breast cancer as genetic predispositions could be helpful for her pregnancy and the health of the baby. It is appropriate to screen and put measures individually with increased risk factors.

Discussions with Elizabeth Jones

In her prenatal visit, it is vital to clarify a few things concerning Elizabeth Jones’ general and fetal safety before the delivery (Office on Women’s Health, 2019). First, her history of domestic abuse necessitates handling it very sensitively and compassionately through offering resources and services that capacitate her to prevent things such as violence and emotional distress. In this respect, smoking when in a pregnant state should be discussed to bring to light the shortcomings of smoking as well as provide a remedy and tips for any person who wants to quit smoking. The next issue is the history of depression and the assumption to cease her medications since unmanaged depression during pregnancy can result in adverse effects for both the mother and the child. Providing adequate counseling, therapy, or medication management options is paramount.

Additionally, Elizabeth should be taught to appreciate prenatal visits for the sake of her and the unborn baby’s health, adopt the appropriate lifestyle, and both her doctors’ and nurses’ directions are followed for chronic hypertension. Apart from risks related to her established health history and family medical history, discussions should also be on potential risks that could arise from the previous C-section, as well as a birth plan that reflects the same.

References

CDC. (2022, April 4). Pregnancy complications. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications.html

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. International Journal of Integrated Care, 21(1), 1–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977020/

Office on Women’s Health. (2019, January 31). Prenatal care. Womenshealth.gov. https://www.womenshealth.gov/a-z-topics/prenatal-care

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

You are a registered nurse (RN) working in a Women’s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jones’s medical and obstetrical history is as follows.

Prenatal Assessment and Care Plan for a 37-Year-Old Pregnant Woman with Chronic Hypertension and Previous Obstetric History

Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papillomavirus (HPV), colposcopy within normal limits
Medical history: Chronic hypertension (HTN) x 5 years;
Allergies: Penicillin
Social history:
(+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” for 15 years
(+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use Abusive partner with first pregnancy, states she has a new partner x 4 years Depression, currently not taking meds for treatment (tx)
Medications: Prenatal vitamins; Labetalol 200mg BID;
Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)
4/21/24
Instructions
Write a two to three-page analysis of this scenario that answers the following questions:
What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases, and depression?
Document the considerations of yourself as a professional nurse in regards to self-awareness; be aware of attitudes, values,s, and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.
What conditions are in Mrs. Jones’s history that would cause concern during pregnancy, labor, and birth? What concerns should be discussed with Ms. Jones before she leaves her appointment?
Each answer to your question should include the following:
A correct answer with thorough development of the topic
Gives clinical examples
Include evidence from scholarly sources
Appropriate use of medical terminology
Format
Standard American English (correct grammar, punctuation, etc.) Logical, original and insightful
Professional organization, style, and mechanics in APA format
Submit document through Grammarly to correct errors before submission