Maternal Child Nursing
Develop a 3-4 pages paper to address the following categories
- Patient personal family and social history pathophysiology (if applicable), and assessment of the patient
- The present plan of care and future recommendations for improvements
- Nursing interventions with rationale
- One primary and secondary nursing diagnosis
- Conclusion to include a nursing implication for practice, education, and or research
- Title and reference page not part of total page count
Narrative form
S.W. is a 16-year-old woman from a semi-remote First Nation community. She is 36 weeks pregnant and attending a prenatal visit with her community midwife. This is her first pregnancy and she has attended all previous visits with her mother and/or Frank, the father of her baby. S.W. is very quiet and makes limited eye contact during these visits. S.W.’s pregnancy has been fairly uneventful. Her weight gain has been 23 pounds. Laboratory values and blood pressure have been within normal limits. A 20-week ultrasound found no abnormalities of fetal anatomy. At her last visit the midwife told her they would be discussing place of birth today. S.W’s options are to deliver in one of two tertiary care centers in a large city 9 hours away, or at a hospital in a smaller city closer to home. S.W. arrives for her visit with her mother and her midwife notices that they seem to be more serious than usual today.
Sample Answer
Patient Personal Family and Social History Pathophysiology (If Applicable), and Assessment of the Patient
SW, the 16-year-old pregnant woman, appears to have grown in a semi-remote area. As a result of growing up in a First Nation community, SW might prefer delivering in a smaller hospital closer to her house as opposed to going to that healthcare facility in a large city that is 9 hours away from her home. By growing in the First Nation community, SW is more likely to be reserved and a bit shy towards new people. On the other hand, the social history of SW is uneventful. The pathophysiological of SW is also eventful because she displays normal vital signs of a pregnant woman, including having normal limits of blood pressure and no fetal abnormalities being observed during her 20-week ultrasound (Amorim et al., 2017). Considering the assessment of the 16-year old patient, who is 36 weeks pregnant, it’s also evident that her condition is normal, with no signs of discomfort associated with her pregnancy.
The Present Plan of Care and Future Recommendations for Improvements
The present plan of care for SW, who is 36 weeks pregnant, would include taking a balanced diet and continuing with regular gentle exercise. A balanced diet that is made up of fruits, vegetables, inadequate carbohydrates, and proteins is important for a pregnant woman. By taking a balanced diet consistently, pregnant woman is able to nourish themselves and their baby and also establish a strong foundation for possible breastfeeding. Taking a balanced diet is also important for a pregnant woman in that being healthy makes it easier for a woman to recover after delivery. As a result of being pregnant, SW should therefore consume at least five servings of vegetables and fruits every day, which includes at least one serving of citrus fruit, two servings of dark green leafy vegetables, and one serving of the orange vegetables (Montgomery, 2016). As a pregnant woman, SW should also take at least six servings of serious and whole-grain bread and at least three servings of low-fat milk, new products, or nonfat milk. SW should also take two to three servings of chicken, extra-lean meat, cooked dried fish and peas, and at least eight glasses of water. Performing regular and continuous gentle exercise is also important for SW in that such forms of exercise can give SW long-term energy. Gentle exercises are therefore walking, which can help to significantly boost the patient’s energy (Montgomery, 2016).
Nursing Interventions with Rationale
The ideal nursing intervention for patient SW who is 36 weeks pregnant, would be to evaluate the position of the fetus. The lie of the fetus should therefore be determined by 36 weeks. In the event that the presenting part is not cephalic, there should be an attempt of an external cephalic version by 38 weeks if the patient has no contraindications (Kern-Goldberger et al., 2021). Ensuring that the lie of a fetus is cephalic will therefore be important because if a pregnant woman was to go into labor with an abnormal lie, they would be at a high risk of rupturing the uterus. Another nursing intervention that is important at 36 weeks is assessing whether a patient has had a cesarean section delivery. This assessment is therefore important to determine the safest method of delivery for a patient. A patient with a small pelvis and who has previously been involved in a classic or cesarean section and has also experienced other recurrent causes for a cesarean section must therefore be advised to book an elective cesarean section by 39 weeks (Kern-Goldberger et al., 2021). However, in the case of SW, who is only 16 years old and is having her first pregnancy, the consideration of a cesarean section will not be necessary. At 36 weeks, it will be important for nurses to discuss with the patient the preferred route of delivery and come up with a determination. The patient will therefore be required to provide their preferred route of delivery with the patient’s preference and the final decision being respected. At 36 weeks, the patient’s breast would also need to be examined for inverted or flat nipples or any case of eczema of the areola that can significantly impair breastfeeding. Any cases of eczema would therefore be effectively treated with a steroid ointment.
One Primary and Secondary Nursing Diagnosis
The central primary nursing diagnosis would include a non-cephalic fetus and while a secondary nursing diagnosis would include eczema of the areola. The lie of the fetus should therefore be determined by 36 weeks. In the event that the presenting part is not cephalic, there should be an attempt of an external cephalic version by 38 weeks if the patient has no contraindications. Ensuring that the lie of a fetus is cephalic will therefore be important because if a pregnant woman was to go into labor with an abnormal lie, they would be at a high risk of rupturing the uterus. On the other hand, eczema of the areola would therefore be effectively treated with a steroid ointment (Kern-Goldberger et al., 2021).
Conclusion
Maternal mortality rates across the world have continued to be significantly high. Globally at least 800 women succumb every day to complications of pregnancy and childbirth. Most of these deaths are therefore preventable, especially when conditions such as hypertension, cardiovascular diseases, and infections are detected and managed early during a woman’s pregnancy. Prenatal care can also help to avoid life-threatening complications in women. However, a lot of progress has been made in preventing maternal mortality, especially in developed countries such as the US, especially when women receive the required levels of care. However, despite the reduction in mortality rates in the US, there’s still a disproportionately high rate of maternal mortality among ethnic minority groups compared to the larger population. Therefore approximately 700 women die every year in the US as a result of pregnancy and birth complications. African American and ethnic minority women have a high rate of pregnancy-related deaths compared to white women, with an average height of two to three times higher (Amorim et al., 2017). Black and ethnic minority women are also at a significantly higher risk of maternal morbidity issues such as preeclampsia which are the more common causes of maternal death. Prenatal care is important among ethnic minority groups such as patient SW in the case study who comes from a first nation community. The involvement of nurses in prenatal care can therefore help to avoid adverse outcomes such as maternal mortality in pregnant women.
