Question

A 24-year-old Caucasian female client presents for her 36 weeks prenatal appointment. She is a G1 P0. She is single and lives with her mom. She is currently working as a certified nurse aid in a nursing home and works 40 hours/week. Her pregnancy was unexpected but making the most of her situation. Her boyfriend lives out if state. She had limited prenatal care since not know she was pregnant until 16 weeks gestation. She has attended prenatal classes at the hospital recently. She is up to date on her vaccinations and thus far her prenatal labs as are as expected. She has a history of irregular menses because of her passion for long-distance running. Prior to her knowledge of this pregnancy she was running 30 miles/week and her BMI prior to pregnancy was 17. Her weight gain at this point has been 15lbs. She plans to attend college after the baby is born. She has hopes to attend nursing school. Her current medications are Tylenol and prenatal vitamins with folic acid.

1. Does the client have any risk factors for preterm labor? If this client calls the clinic and reports vaginal discharge or any leakage of fluid, what questions should the nurse ask?
2. This client inquires about labor, discuss the difference between true labor vs false labor?
3. Considering her history, what other items are of concern?
4. Discuss the expected feelings/behaviors that the nurse should discuss with this client.
5. Develop a plan of care with the utilization of the nursing process regarding one of the items of concern identified.

Answer 1

1. Since she had a BMI of 17, this makes her underweight prior to her pregnancy. So she might have a risk of preterm labor.

2. Questions I would ask would be:

• What was the color of the discharge?
• Was the odor of the discharge fowl?
• Was there any type of swelling or burning in the vulvar region during the discharge?

3.False labor: contractions are often irregular and do not get closer together. True labor: contractions come at regular intervals and get closer together as time goes on. (Contractions last about 30 to 70 seconds.).

4.Early prenatal care must be taken around 1-3 months of gestation. Here she started taking her prenatal after the 1st trimester, which made her miss her prenatal during it. So the baby can have a low birth weight and five times more likely to die than those born to mothers who do get care.

5.During pregnancy, and in the postnatal period, there are significant changes in a woman's hormone levels. This can have an effect on how they may feel or behave. Women are often more emotionally up and down during pregnancy and less able to cope with normal stresses than usual.

So as a nurse I would advise her not to stress herself a lot when it comes to sensitive issues and take everything with a pinch of salt