Question

Having some trouble with my case study questions please.

“Aaaargh!”

Susan Pohl, Family Nurse Practitioner, felt extremely frustrated as she left Room 12. She had just spent the last 30 minutes with Lydia Lopez-Rivera, a developmentally disabled, 30-weeks-pregnant, 19-year-old Latina. “What’s wrong, Susan?” asked Bernie Candales-Mitterman, the group’s social worker.“I’ve just spent the last half-hour with Lydia Lopez—you know, the pregnant girl. I’m just so upset! She’s missed several

appointments, even though I had the nurses call her. She was late today, as usual. She’s missed several important tests that need to be done during the second trimester. She’s here today with another urinary tract infection because she didn’t finish all the antibiotics from the last infection—they made her sick and she didn’t call us to let us know she had stopped them, even though I gave her specific verbal and written instructions. Now she’s got large quantities of ketones in her urine. On top of that, her blood type is Rh negative. I’ve worked hard to try to prevent anything from happening. I just don’t know what to do!”

“I understand your frustration. What was her excuse for missing the appointments?” asked Bernie.

“That’s just it!” exclaimed Susan. “She has no excuse. She just sits there and smiles. The more I try to talk to her, the quieter she becomes.”

“Any luck setting up help for her? I know she’ll need it with her mom out of the picture and her boyfriend working,” said Bernie.

“Another frustration. The red tape. The forms they want filled out. I just know she won’t have any help when that baby comes.” Susan sat down and held her face in her hands. “This is just what I tried to avoid by keeping her here with usin our family practice rather than transferring her to the high-risk clinic at Children’s Hospital. I didn’t want her to ‘get lost,’ but that seems to be exactly what has happened. What should I do?”

Questions

1. What is your diagnosis of this patient?

2. How would you treat the various problems?

3. What are the psychosocial issues?

4. What are the ethical issues?

5. How does the nurse practitioner feel?

6. How would you feel caring for this patient?

Answer 1

Answer 1) I can frame two important nursing diagnosis for this patient.

a) Self care deficit related to developmental disability evidenced by reoccurrence of urinary tract infection.

b) Impaired communication related to developmental disability evidenced by reduce verbal conversations.

Answer 2: In order to treat the various problems like lack of knowledge, poor hygiene, social withdrawal, not sticking to treatment regimen, She really needs a good Family Nurse Practitioner who wants well being of her client rather than doubting the efficacy of her client and making negative reactions on her. Remedies that will be helpful in this condition are:

• Providing knowledgeable and informative class taker who can understand their disabilities and can describe the possible effects on pregnancy and labor.
• Pregnancy in a developmental disability women is a same as in a non disability women. In both condition they have the right to be pregnant so the Healthcare associating with such cases should never make any negative reactions like encouraging termination of pregnancy.
• Nurses who is involved in the prenatal care of such clients should make efforts to identify the questions and concerns of women about perinatal care and develop strategies and modifications needed in order to help them in taking care of infants.
• These women tend to be afraid in taking any medication, fearing the potential side effects that may occur with its conception. So the health care provider should elaborate the potential effects of medications given during pregnancy and its effects on fetus so that they may cooperate with the treatment regimen.
• Maintaining a healthy Nurse client relationship with good interpersonal communication.

Answer 3: Psychosocial issues involved in this case are:

• non cooperative client with treatment regimen.
• social withdrawal as evidenced by the unwillingness to answer the questions of concerned health practitioner.
• Fear of experiencing negative comments about her pregnancy in her perinatal visit.
• Lack of family support.

Answer 4: Every staff may not be as willing to take up the challenge of taking care for such patients. The issues that develop are:

• The healthcare provider has minimal assistance to care for such patients.
• She may have to act as a advocate for them rather may act as a strong advocate to speaker up for them.
• She becomes the only decision maker thus have a conflict in deciding what is right and wrong.