Question

Trina and Rick are new clients at your obstetrics office. They are both 25 years old. You are asking them about the reason for their visit. Trina says she thinks she is pregnant because she missed a period, again. Her last normal menstrual period was 07/03/2020. Rick tells you Trina is always nauseated all the time. They have not been using birth control and have wanted to have children since they got married last summer. Trina says her clothes are feeling tighter and her breasts seem tender, but that happens every month with her cycle. Rick says he has noticed that Trina has been frequently getting up to go to the bathroom at night. Trina is concerned because she has a half-brother who has Down syndrome, had one miscarriage at age 22 and she had one elective abortion when she was 20 years old.

1. What subjective symptoms have led Trina to presume she is pregnant?

2. What other conditions could be the cause of Trina’s symptoms?

3. How can a pregnancy be confirmed as probable in the office?

4. What three methods can be used to diagnose a pregnancy as positive?

5. The urine pregnancy test comes back positive. What is Trina’s due date?

6. What is Trina’s obstetric history (GTPAL format) at this time?

7. What education would you provide to Trina about genetic testing options, what time frame would they be offered, and what information can be obtained from these tests?

8. Name three physiologic changes during each trimester of the pregnancy that the nurse would teach to the couple.

9. Discuss anticipatory guidance about managing the physiologic changes the nurse would expect to educate the couple on during each trimester of the pregnancy.

10. Discuss the nursing management of the pregnant client in each trimester of pregnancy (visits, warning signs, additional testing, etc.).

Answer 1

ANSWERS:-

1) What subjective symptoms have led Trina to presume that she is pregnant?

* She missed her period,and her last menstrual period was 07/03/2020.

* Feeling nauseated all the time

* Feeling tenderness on her breasts and clothes are tight

* Frequent urination at night.

2) What other conditions could be the cause of Trina's symptoms?

* Pre-menstrual symptoms

3) How can a pregnancy confirmed as probable in the office?

Pregnancy can be confirmed in the office with the presence of these signs-

Probable signs of pregnancy include -

* Amenorrhea - absence of menstrual period in a women having regular periods during reproductive age .

* Morning sickness- Nausea,loss of appetite and sometimes vomiting,especially on rising from bed.

* Frequency of micturation- due to resting of bulky uterus on the bladder and changes in maternal osmoregulation.

* Breast changes - enlargement of breast,nipple and primary areola become more pigmented, appearance of secondary areola,development of montogomery tubercles ,discomfort and feeling fullness in breast,tenderness,and pricking sensation.

* Cervix- becomes soft.

* Fatigue

*Bloating of abdomen

4)Three methods used to diagnose a pregnancy as positive are-

a) History and physical examination FOR PROBABLE SIGNS OF PREGNANCY- menstrual history, identifying subjective and objective symptoms like amenorrhea ,morning sickness ,breast changes, pelvic changes like Jacquemier's sign( Discoloration of vestibule and anterior vaginal wall due to vascular congestion),vagina become soft,with copious mucoid discharge,cervix becomes soft etc

b) Laboratory investigations-

* Testing for presence of HCG( Human Chorionic Gonadotropin ) in the maternal urine and serum indicate pregnancy

c) Ultrasonography ( positive signs) - To identify intra decidual gestational sac ,

* Auscultate fetal heart sound.

5) Trina's due date is -

* EDD- Estimated Due Date or Expected Date of Delivery is calculated by adding 280 days or 9 months and 7 day to first day of last menstrual period(LMP).

* Trina's LMP was on 07/03/2020

* EDD= 07/03=280

* March -25 days

* April- 30days

* May- 31days

*June- 30days

* July- 31 days

* August - 31days

*September- 30 days

* October - 31 days

* November- 30 days

* December- 11 days

** EDD is 11/12/2020( 11th December 2020)

* 9 months 7days = December 14th 2020

6) Trina's obstetric history (GTPAL format) at this time is G3T0P0A2L0.

* Gravida( number of pregnancy)- G3

* Term births ( number of full term delivery)- T0

* Preterm births( number of births before 40 weeks of gestation) - P0

* Abortions /miscarriage - A2

* Living ( Number of living children) -L0