Assessment of a Pregnant Client

Assessment of a Pregnant Client

Factors the Nurse Should Consider for the Client

Safety

Ensuring the safety of the client is paramount. The nurse should assess the current situation for any signs of ongoing abuse and take appropriate measures to protect Elizabeth and her unborn child. This may include providing information on support services, creating a safety plan, and reporting abuse if necessary (Silbert-Flagg, 2022).

Trauma-Informed Care

Recognizing the impact of past trauma is crucial. The nurse should approach Elizabeth with empathy, sensitivity, and respect. Building trust and establishing a therapeutic relationship help create a safe environment for open communication and disclosure of sensitive information (Linde et al., 2020).

Substance Use

The nurse should assess the extent of Elizabeth’s past cocaine use and inquire about current drug use. Substance abuse during pregnancy can adversely affect both the mother and the fetus (Knott, 2022). The nurse should provide education about the potential risks and encourage cessation of drug use. Referral to a substance abuse counselor or support group may be beneficial.

Sexually Transmitted Diseases (STDs)

The nurse should inquire about the type and treatment of STDs Elizabeth has had in the past. Proper screening and treatment for STDs are crucial during pregnancy to prevent complications such as preterm labor, low birth weight, and transmission to the newborn (Knott, 2022). The nurse should ensure that Elizabeth receives appropriate testing and treatment.

Depression

The nurse should assess the severity of Elizabeth’s depression and evaluate her current coping strategies. Depression during pregnancy can increase the risk of preterm birth, low birth weight, and developmental issues. Collaborating with a mental health professional is essential to develop an appropriate treatment plan, including therapy, medication, or a combination.

Multidisciplinary Approach

Given the complexity of Elizabeth’s history, a collaborative approach involving healthcare providers, social workers, mental health professionals, and support services is crucial. Coordinated care ensures comprehensive assessment, intervention, and follow-up for Elizabeth’s health and well-being.

Documentations as a Professional Nurse for Self-Awareness

Recognize and Challenge Biases

Our cultural background, upbringing, and personal experiences influence our inherent biases. Reflecting on these biases and actively challenging negative stereotypes or prejudices is important. This includes examining our attitudes toward clients who have experienced domestic abuse, drug use, STDs, or mental health issues (Knott, 2022).

Practice Empathy and Non-Judgment

It is essential to approach each client with empathy, withholding judgment and preconceived notions. By actively listening to their experiences and perspectives, nurses can better understand clients’ needs and provide individualized care that respects their autonomy and dignity (Linde et al., 2020).

Seek Diverse Perspectives

Engaging in open dialogue with colleagues, participating in multicultural training programs, and seeking mentorship from individuals with diverse backgrounds can broaden our understanding of social issues and promote cultural sensitivity (Knott, 2022).

Reflect on Personal Limitations

It is important to acknowledge that we may not have firsthand experiences or a deep understanding of certain social backgrounds. When faced with unfamiliar situations or challenges, seeking guidance from colleagues, consulting interdisciplinary team members, and accessing evidence-based resources can enhance our ability to provide comprehensive care (Silbert-Flagg, 2022).

Conditions Causing Concern

History Of Cesarean Section

Mrs. Jones had a previous Cesarean section due to non-reassuring fetal heart tones. This increases the risk of uterine rupture in subsequent pregnancies, especially if she attempts a vaginal birth after a Cesarean (Silbert-Flagg, 2022). The nurse should monitor Mrs. Jones during labor for signs of uterine ruptures, such as abnormal fetal heart rate patterns or sudden abdominal pain.

Chronic Hypertension

Mrs. Jones has been diagnosed with chronic hypertension for five years. Hypertension during pregnancy increases the risk of preeclampsia, gestational hypertension, fetal growth restriction, placental abruption, and preterm birth (Chandrasekaran et al., 2022). The nurse should closely monitor Mrs. Jones’s blood pressure throughout pregnancy and provide appropriate antihypertensive medication as prescribed to maintain optimal blood pressure control.

Substance Use History

Mrs. Jones has a history of cocaine use, although she states she has not used any drugs for more than a year. Substance use during pregnancy can harm the mother and the fetus in various ways, including preterm birth, low birth weight, developmental issues, and complications during labor (Knott, 2022). The nurse should assess Mrs. Jones’s current substance use status, educate her about the risks, and provide support and cessation program resources.

Depression

Mrs. Jones is currently experiencing depression and is not taking any medication for treatment. Untreated depression during pregnancy can impact maternal well-being and increase the risk of adverse outcomes such as preterm birth and low birth weight (Linde et al., 2020). The nurse should collaborate with a mental health professional to develop an appropriate treatment plan, including therapy, medication, or a combination of both, to ensure Mrs. Jones’s emotional well-being throughout pregnancy.

Concerns to be Discussed with Ms. Jones

Importance of Prenatal Care

Emphasize the significance of regular prenatal visits for monitoring the health of both the mother and the baby. Discuss the schedule of appointments, recommended tests, and screenings (Silbert-Flagg, 2022). Reinforce that consistent prenatal care can help identify and manage potential complications or risks.

Blood Pressure Management

Given Ms. Jones’s history of chronic hypertension, stress the importance of monitoring her blood pressure regularly. Discuss the potential risks associated with high blood pressure during pregnancy and the measures she can take to control it, such as following a low-sodium diet, engaging in regular physical activity, and taking prescribed medications as directed (Chandrasekaran et al., 2022).

Substance use Cessation

Discuss the potential risks associated with tobacco use during pregnancy, including increased chances of preterm birth, low birth weight, and complications. Provide resources and support for smoking cessation, such as referrals to cessation programs and counseling services (Knott, 2022). Reinforce the importance of abstaining from drug use throughout pregnancy and the potential harm it can pose to the baby.

Mental Health Support

Inquire about Ms. Jones’s current mental health status and any symptoms of depression. Discuss the importance of seeking treatment for depression during pregnancy and available resources for mental health support, such as therapy or counseling (Linde et al., 2020). Furthermore, encourage her to reach out for help if needed and provide information on local mental health services.

References

Chandrasekaran, Suchitra,M.D., M.S.C.E., Badell, M. L., M.D., & Jamieson, Denise J,M.D., M.P.H. (2022). Management of Chronic Hypertension During Pregnancy: The Journal of the American Medical Association. Jama, 327(17), 1700. https://doi.org/10.1001/jama.2022.3919

Knott, K. (2022, Sep 16). The lifelong effects of substance abuse during pregnancy: Non-profit groups are sounding the alarm and spreading awareness of the damage caused. South China Morning Post https://www.proquest.com/newspapers/lifelong-effects-substance-abuse-during-pregnancy/docview/2714747866/se-2

Linde, v. L., Chia, A., Phua, D., Colega, M., Padmapriya, N., Bernard, J. Y., Cai, S., Tham, E. K., Teoh, O. H., Goh, D., Gooley, J. J., Gluckman, P. D., Yap, F., Shek, L. P. C., Godfrey, K. M., Tan, K. H., Yap-Seng, C., Muller-Riemenschneider Falk Müller-Riemenschneider, Broekman, B., . . . Chong, M. F. F. (2020). Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort. Comprehensive Psychiatry, 103https://doi.org/10.1016/j.comppsych.2020.152210

Silbert-Flagg, J. (2022). Maternal & child health nursing: care of the childbearing & childrearing family. Lippincott Williams & Wilkins.

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Module 03 Case Study – Assessment of Pregnant Client
Module 03 Content

Purpose of Assignment
Utilize the appropriate technology and/or references/resources, demonstrating accurate use, in order to access reliable data and information that support evidence-based practice in the care of diverse clients during pregnancy.
Differentiate the various components of basic physiological needs as it relates to pregnancy and health practices, including but not limited to associated concepts of.

Evaluate data and information gathered during client care, simulated scenarios, and/or case studies related to promoting nutritional health during pregnancy, nursing care strategies to address the common discomforts of pregnancy, essential components and standards of prenatal care, fetal growth, and development stages in order to determine knowledge and wisdom gained through critical thought processes to optimize client outcomes and quality improvement.
Demonstrate a basic understanding of communication practices necessary for client-centered care and interdisciplinary collaboration in terms of knowledge, skills, and attitudes.

Competency
Apply appropriate nursing care interventions for clients during pregnancy, labor, and birth.

Scenario

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.