Posted: December 18th, 2022
Clinical Guidelines for Procedures and Screenings.
After confirming and dating a pregnancy, you must collaborate with patients to develop a personalized care plan. These pregnancy care plans are integral to prenatal care as they help to ensure the mother and child’s well-being throughout the entire pregnancy. Pregnancy can be a wonderful, yet difficult time for women as a woman’s body goes through many physical, mental, and emotional changes that might be challenging or even overwhelming for some.
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Whether or not these women share their concerns, as the advanced practice nurse, you must routinely watch for signs and symptoms of any developing physical or mental health issues. By collaborating with patients and discussing concerns, you can modify care plans and often address potential issues before they become a significant health problem. For this Discussion, consider pregnancy care plans for the women in the following case studies: Case Study 1: On 1-15-13, you are seeing a 25-year-old Caucasian female in the clinic because she believes she’s pregnant. Her LMP was 12-1-12. Her home pregnancy test was positive, and she has been having nausea and breast tenderness.To prepare: Review Chapter 30 of the Schuiling and Likis text and Chapter 2 of the Tharpe et al. text. Review and select one of the two provided case studies. Analyze the patient information. Consider how to date the pregnancy and estimate the date of delivery for the patient in the case study you selected. Based on the dating of the pregnancy, reflect on the appropriate clinical guidelines for procedures and screenings. Think about the implications of any missed procedures or screenings. Determine a plan of care for the patient. Identify procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments (if appropriate), management strategies, and patient education. write on the estimated date of delivery for the patient in the case study you selected. Include an explanation of how you dated a pregnancy and which of the patient’s factors led to your estimated date of delivery. Then, based on the dating of the patient’s pregnancy, explain the appropriate clinical guidelines for procedures and screenings. Explain implications of any missed procedures and/or screenings. Finally, explain a plan of care for the patient, including procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments, management strategies, and patient education.
This case study involves a 25 year-old Caucasian female who strongly believed that she was pregnant. The patient’s LMP was 12-1-12 with a positive pregnancy test that was done at home. The patient also reported of some breast tenderness and nausea.
EDD (Estimated Date of Delivery)
Based on the history provided by the client and the LMP, the estimated date of delivery using Nagele’s Rule with an assumption that she has a 28-day cycle is 9-8-13. In case the client has a 30-day cycle, the estimated date of delivery will be on 9-10-2013 and on 9-6-2013 for a 26-day cycle (Tharpe, Farley & Jordan, 2016). Besides, the clients presenting symptoms of breast tenderness and nausea are early signs of pregnancy. Additional signs may include: vomiting, fatigue and frequent urination. Although the client conducted a home pregnancy test that turned out to be positive, an office urinary pregnancy test will also be done for the purposes of documenting a verified pregnancy.
Clinical Guidelines for Procedures and Screenings
During the initial visit, it is vital to take a detailed history including the familial, medical and obstetric histories. Besides, history taking will enable to assess the level of support she receives from friends and family, the health insurer and her occupation to determine whether or not it possess significant dangers to the patient (Tharpe, Farley & Jordan, 2016). Besides, it is essential to assess the birth control method used before conceiving for safety such that, if it was an IUD, it should be removed promptly. Other essential aspects that should be assessed during history taking include: immunizations, history of infectious diseases, exposure to toxins, alcohol, illicit drugs use and medications. The client will also require a comprehensive bimanual examination and physical assessment which will help to approximate the size of the uterus and assessing for adnexal tenderness to rule out the likelihood of an ectopic pregnancy (Tharpe, Farley & Jordan, 2016). The initial lab work to be done will include: a complete blood count, screening for hepatitis B, Syphilis, HIV, gonorrhea and chlamydia. Additional tests to be ordered will be determined by the client’s familial and medical history with regards to dysfunctioning of the thyroid, diabetes and varicella among others.
Missed Procedures and/or Screenings
Screening tests during the prenatal period provide details on the possible risks that both the mother and fetus are predisposed to. A perfect example is diabetes screening or genetic testing for Downs syndrome. Screening tests are essential in guiding decision making with regards to reproductive choices such as whether or not to terminate a pregnancy (De Jong, Maya, & Van Lith, 2015). Alternatively, they also provide details on how health risks of the fetus or mother can be minimized in the entire pregnancy period. This clearly reveals that missed screening or procedures can be harmful to the fetus, the mother or both and result to poor health outcomes.
Plan of Care
Upon completion of history taking, physical examination, screening and lab work, it is vital to give education and therapy based on the patient’s needs. The client should be prescribed folic acid among other prenatal vitamins, be immunized, be informed on pregnancy danger signs, how to manage and modify any underlying conditions and to manage symptoms. Education on the dietary sources of specific nutrients is also mandatory to ensure a healthy pregnancy (Peyton, et al., 2014). The client should also be educated on the dangers of smoking, alcohol intake and illicit drug use and be advised to avoid them during pregnancy and after delivery. The client’s access to a well-equipped healthcare facility within her environs and available community resources should also be discussed (Peyton, et al., 2014). Since in each obstetric visit there are opportunities to learn and teach based on gestational age, the patient should be encouraged to attend. This information may be repeated in the entire period of pregnancy.
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