Question

Two references and in APA citation format.

Nancy, is an African-American age 41-years-old, and her husband, David, age 47, arrive at a midwife clinic for an initial prenatal visit. They have been married for 10 years and trying to have a child for 3 years. Nancy completes the initial paperwork and the nurse notes the following obstetrical history: G3, T0, P0, A2, L0. Nancy is approximately 8 weeks pregnant. What questions in the history are the highest priority for the nurse to ask, given Nancy’s obstetrical history? Why is this history important?

What initial prenatal screening and testing would the nurse anticipate at this visit? Why?

What prenatal screening and testing would the nurse anticipate for Nancy in the future related to her age? Why?

What education topics are important for the nurse to discuss with Nancy at this prenatal visit? (list at least 4) Why?

Answer 1

Answers-1

a) Questions ask during obstetrical assessment are,

1. Do you have any health issues like cardiac disease, hypertension, thyroid issues, anaemia, chronic lung disease, seizure disorders, diabetes?

2. Explain your previous pregnancy loss, in which gestational age?If there any placental or genetic abnormalities in the past pregnency? explain about your pregnancy complications in the past?

3. Are you a smoker or alcoholic aur any history of drug usage both prescription and non prescription?

4. Do you have any psychological issues?

5.Do you take any treatment for hormonal imbalances?

6.Do you have any history of sexually transmitted infection in the past?

b)why this questions important?

Previous child bearing experiences have an important part to play in possible outcome of prediction of the current pregnancy.A systemic non- judgemental approach is required to elicit information and encourage the women to talk freely about their experience of previous births, miscarriages, or terminations. The women may be more anxious about the pregnancy and will usually be relieved when it progresses past date of previous loss. For completeness of history, reference to old case notes should be made to elicit all the relevant information. A risk assessment should be carried out based on the women's obstetric, medical and social history and current pregnancy.

2. Initial Screening and testing in current pregnancy

• Examinations of blood; for hemoglobin estimation,ABO and Rh grouping and test for VDRL. Screening for blood glucose is done in selected cases.
• Urine is examined for protein, sugar, and pus cells. If protein is found ," clear catch" specimen of midstream urine is collected to test albumin. If protein is still present then full urine analysis has to be done.
• Cervical cytology study by pap smear.
• Serological tests for rubella and hepatitis B Virus.

The aims of prenatal screening and testing are,

• To screen high risk case.
• To prevent or to detect and treat at the eariest.
• To ensure continued medical surveillance and prophylaxis.

3.Answers

• Maternal serum alpha feto protien (MSAFP) estimation or triple test at 16-18 weeks to detect chromosomal anomalies like down syndrome and neural tube defects. this types of chromosomal anomalies occur more often with increasing age of women.Moreover,Mrs.Nancy has a history of previous miscarriages.Chromosomal abnormalities are behind the 60-70% of first term miscariages.
• Ultrasound examination -Trans abdominal or trans vaginal - Helps to detect gross fetal abnormalities,placental abnormalities and any uterine adnexal pathology.

Risk of pathological conditions such as molar pregnancy and antinatal haemorrhage is increased with aging of mother.

• Routine abdominal and vginal examination- To assess the development of fetus and pelvis

4 answers

antenatal education

• Teach the importance of routine health checkup through out the pregnancy.

* Urine.weight, Hb estimation,,blood pressure should be checked every visit.

* Ensure you receive IFA tablets and 2 doses of Tetanus Toxoid

• Healthy diet, - a well balanced diet including, lean meats, fruits, vegetables, whole grain breads, low fat diary products, proper consumption of calcium, iron and folic acids.
• Drinking of enough fluids due to increased body demand and avoid constipation
• Moderate intensity exercise activity as in advise of physician.
• Adequate rest and sleep for 8 hours
• Always consult the MO if necessary orreferred.
• Personal hygiene prevents acquiring infection.
• Proper examination and care of breast,to prevent engorgement.

referances

• .Fraser ,Cooper( 2009) .Myles text book for midwives.fifteenth edition,Churchil Livingstone,Elsevier publications.
• Dutta D C(2001)Text book of obstetrics,Fifth edition,Central publications.