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.

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 papilloma virus (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)

Instructions

Write a two to three-page analysis of this scenario that answers the following questions:

1. What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression?
2. Document the considerations of yourself as the professional nurse in regards to self-awareness; be aware of attitudes, values and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.
3. What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?
4. 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