Research Topics: Prenatal Care

Case Study on Antenatal Period

Antenatal Period: Della was admitted to the antenatal ward from triage at 35 weeks and 2 days into her fourth pregnancy as it was thought by the triage midwife that she was in premature labour. My mentor and I took care of Della and were the primary care givers. Della had a lot of self-referral admissions to the antenatal ward (this was her 8th admission). She had admissions for many reasons such as pain in the abdomen and reduced fetal movements, all of which involved short stays on the ward and Della being discharged reassured that the pregnancy was progressing well. As well as these visits to the ward Della had also had regular consultations with the urology team concerning her hydronephrosis and the nephrostomy tube which she had in situ to allow urine drainage. In this pregnancy the nephrostomy tube was inserted when Della was 20 weeks pregnant. After being introduced to Della, I went on to perform an abdominal examination with Della’s consent. I then listened to the baby’s heartbeat using a pinnard stethoscope. The doctor that had seen Della in triage requested an admission cardiotocograph trace to monitor the baby’s heartbeat which had not been done in triage because it was busy over there and Della had appeared to be in a lot of pain. This information was all comprehensively documented in Della’s notes and highlights the importance of reading women’s notes thoroughly and promoting the importance of effective record keeping (NMC, 2004). My mentor and I noticed that during the 20 minutes that we were with Della she didn’t appear to have any contractions or be in any pain. Just as we were about to leave the room Della’s husband arrived and her mood seemed to change very quickly. She became very tense and said that she was in pain and appeared to be having a contraction. Della is admitted to the Antenatal Unit for labour and then moved to the delivery suite, where the Delivery Summary will be completed. Labour Period: It can be said that the process of giving birth is a dramatic event in the life of placental organisms, because it demarcates the change from an aquatic to a terrestrial existence. The process of Della’s labour is not quite easy for the care team as there needs to learn about and adapt to the uterine environment in order to prepare Della for the postnatal life. Henceforth, the inability to directly observe and quantify fetal behavior during gestation led to much speculation by clinicians concerning the development of fetal state, movement and sensory capacity. Thus, the form of midwifery care focused on serving both the physical and emotional needs of the woman, providing her with information and following her lead in how she wanted to give birth. Postnatal Period: The care during the postnatal period is often provided by multiple caregivers and midwives of whom there is work in the antenatal clinic and or in the postnatal unit along with the continuity of care which is provided to Della by the health care team or a small group from pregnancy through the postnatal period. The postnatal care is very helpful in coping with the emotional and physical demands of motherhood which is packed with lots of practical help and advice to help them get the support they need as the midwife will visit the next day and will visit often as necessary. During the first few weeks after birth, both the midwife and health visitor will have to offer advice and support that Della need as much as possible. Evaluation of Evidence The consistent division between primary and secondary obstetric care for Della can be based on the principle that pregnancy and childbirth are basically natural events on a large scale by independent midwives. Thus, midwives are trained in recognizing early signs and symptoms of pathology and they are competent to do minor obstetric interventions per se. In their philosophy, the guidance of physiological pregnancy and birth requires a non-interventionist attitude that stimulates the confidence of the women in their own potential to give birth (Benoit, et al, 2001). Indeed, in most general hospitals it is possible for midwives and general practitioners to assume responsibility for deliveries. The midwife will guide Della during her pregnancy, delivery and postnatal period. Thus, adequate obstetric risk selection is an essential condition for the effective operation and the division of labour between obstetricians and midwives. The importance of interpersonal skills and multidisciplinary work Interpersonal skills and multidisciplinary work is important for the case situation dealing with Della as there has been the government’s policy to promote primary health care in the case of primary obstetric care as well as home births (Benoit, et al, 2001). This will be aimed at maintaining and in strengthening the delivery during pregnancy stage and the regularization along with the aim of the guidelines in promoting a well desired pregnancy and the giving of birth. This will also guide in establishing a sound relationship among Della and the care team within the assurance of better health service for pregnant women with certain case situations and in integrating better channels of communication during the total process as it is an important factor in determining a good rapport and camaraderie within the people involved and to resolve whatever underlying issues there is in the main areas of concern in terms of proper process of decision-making among the two parties. The mother and fetus made a recovery and the pregnancy has been successful due to the contribution of the skills and the discipline needed during and after Della’s pregnancy. Awareness of professional accountability in aspects of the care delivery Maternity application allows doctors, midwives and nurses to monitor antenatal, delivery and postnatal activities for their patients which captures data relating to child delivery and care in order to ensure quality care for the mother and her newborn. As the date of delivery approaches, the hospital monitors the expectant mother and the hospital staff are prepared for any unexpected occurrences such as complications. The purpose of the midwife care management is to identify any problems and manage them in the best possible way. The decisions that Della will make about her care and her involvement in the care are important. Being involved will help make sure that she feels comfortable with everything that is done in the process. Midwifery care models: Birth centers are separate from regular hospital care, but located close by the labour wards within the hospital. In a birth centre, midwives usually care for Della during her pregnancy, birth and after birth. Often the same midwife team supports a woman through pregnancy and birth. Birth centers feel more home-like and less clinical than hospital labour wards. Antenatal management takes place in the hospital setting generally in a dedicated outpatient clinic area. The woman may not see the same midwife through her pregnancy and those caring for her during the antenatal period may not be involved with the postnatal period.  Pregnant women should be offered evidence-based information and support to enable them to make informed decisions regarding their care. Information should include details of where they will be seen and who will undertake their care. Addressing women’s choices should be recognized as being integral to the decision-making process. There needs to be a schedule of antenatal appointments. For a woman having complicated pregnancy, a schedule of ten appointments should be adequate. Pregnant women should also be offered an early ultrasound scan to determine gestational age and to detect multiple pregnancies. This will ensure consistency of gestational age assessments, improve the performance of mid-trimester serum screening for Down’s syndrome and reduce the need for induction of labour after. Lastly, there needs to have ample support for pregnant woman with hydronephrosis and therefore is accountable for the appropriate care and attention she needs respectively. Credit:ivythesis.typepad.com

Case Study on Antenatal Period

Antenatal Period: Della was admitted to the antenatal ward from triage at 35 weeks and 2 days into her fourth pregnancy as it was though...

Child Having a Child: A Teenage Pregnancy Case Study

Tina: Child Having a Child   Adolescent pregnancy continues to be a major social challenge for the United States. It has the highest rate of teenage pregnancy yearly as compared to other developed nations (Hockenberry, 2003). Adolescent pregnancy occurs across socioeconomic classes, in public and private schools, among all ethnic and religious backgrounds, and in all parts of the country. Tina, is just one of the thousands of teenage girls who have gotten pregnant and had a child. At 15, it cannot be denied that she is still in her transition from childhood to adulthood. Adolescents are at high risk for preterm labor, probably because their uteruses are not fully grown. Because their own development is still immature, adolescents are prone to cephalopelvic disproportion during labor and birth. Adolescent labor does not differ from labor in the older women if cephalopelvic disproportion is absent (Pillitteri, 2003).             Young adolescents are more prone to postpartum hemorrhage than the average woman because if a girl’s uterus is not yet fully developed, it becomes overdistended by pregnancy. An overdistended uterus does not contract as readily as a normally distended uterus in the postpartum period. Adolescents also may have more frequent or deeper perineal and cervical lacerations than older women because of the size of the infant in relation to their body. On the other hand, young adolescents are generally healthy and have supple body tissue that allows for adequate perineal stretching. If a laceration does occur, it usually heals readily without complication (Pillitteri, 2003). At first, the vaginal discharge is grossly bloody and Tina should not get alarmed by this. Over the next 10 to 12 days, the color of the discharge changes to pale brown and finally to yellowish white. External sanitary pads may be used to absorb the discharge. The clinical manifestations of the puerperium, the 6-week period following delivery, are numerous and variable but generally reflect reversal of the physiologic changes that occurred in pregnancy. Within the first 24 hours, it is normal for Tina’s pulse rate to drop and her temperature slightly elevated. It is also normal for Tina’s urine to be temporarily increased in volume and may contain protein and sugar. These events are mild and temporary and should not be confused with more serious conditions.             The immediate postpartum period may be an almost unreal time for an adolescent like Tina. Giving birth is such a stress and a major crisis that all women have difficulty integrating it into their life. it may be particularly difficult for the adolescent. The girl may “block out” the hours of labor as if they didn’t happen. Tina should be urged to talk about labor and birth to make the happening real to her; otherwise, postpartum depression can occur (Pillitteri, 2003). Breast engorgement may become very painful during early lactation when the amount of milk is beginning to increase. Tina’s difficulty in breast feeding could be attributed to this. Analgesia, properly fitting support nursing brassiere, ice packs, and sympathetic competent nursing care will ease Tina’s temporary difficulty. Furthermore, Tina may have to manually express her milk just before nursing to allow the baby girl to get the swollen areola into her mouth. Excessive expression of milk between feedings encourages continued engorgement, therefore this should be done only to relieve discomfort. If Tina decides she is not going to breastfeed because of other reasons provided that the baby will still be properly fed, lactation can be suppressed by a variety of methods. However, nurses and even the whole health care community strongly encourages mothers to breastfeed their baby during the first few months after birth.             Breastfeeding provides optimal nutrition, protection against infection, and a safe, reliable food source for babies–attributes that are critical in emergencies (Barrett, 2006). Given adequate support and encouragement, Tina can nurse her baby girl successfully. The chief contraindication to this would be a lack of desire and interest on the part of Tina. If in the first place the mother does not have the desire to breastfeed the baby, then no amount of encouragement and support can make the mother overcome the difficulties of breastfeeding.             Unfortunately, most adolescent mothers are like Tina, they have difficulty breastfeeding or do not breastfeed at all. This is related to their perception of breast-feeding as something that will “tie-me-down” and the reality (in many instances) that they will be returning to school full-time soon after birth. Education about the importance of breastfeeding and tips for how to incorporate it into a busy lifestyle can increase the number of adolescents breastfeed (Pillitteri, 2003).             Adolescents show the same positive bonding behavior with their infants as their more mature counterparts. They may, however, lack knowledge of infant care. Although they may consider themselves to be knowledgeable in child care because they baby-sat for a neighbor’s child or a younger sibling, they can be overwhelmed in the postpartum period to realize that when the baby is their own, child care is not as simple as it once seemed. When the child cries, they cannot hand it to someone else; at the end of 4 hours, when they are tired of caring for the baby, they cannot leave and walk away. Teenage pregnancy with early prenatal supervision is considered less harmful to both mother and child. Pregnant teens need special attention to nutrition, as well as health supervision and psychological support. It is important to assess how prepared each family is to care for their infant at home, to be sure the newborn remains safe. Tina, as well as her parents may need to make changes in their routine, such as shifting their usual dinner time or work schedule in order to take care of the newborn. Sleep schedules are certain to be disrupted, because infants wake during the night for about the first 4 months of life.             The nurse and other healthcare professionals should assess if local support organization within Tina’s community is available for referral. It should be suggested that Tina and her parents keep telephone numbers of support groups and lactation consultant available in case Tina needs additional help while she is at school. The rationale for this is that support can go a long way toward preventing a client from becoming discouraged.             A teaching plan is designed to help Tina through her postpartum concerns. Assessment factors to be considered in formulating a teaching plan for a client involves individual, significant others, socioeconomic, cultural, disease, nurse- related, nursing priorities, and discharge goals. On the individual level of Tina’s assessment, her age and emotional response to current situation are to be considered. Family development cycle as well as the marital status of Tina also has to be considered on the Significant others level. On the socioeconomic level, her family’s finances, the employment of family members, and social acceptability of the condition are to be considered. Ethnic background and beliefs regarding caring are cultural factors. Nursing priorities include reducing anxiety or fear, facilitate integration of self-concept and body-image changes, encourage effective coping skills, and promote safe environment/patient well-being.             A teaching plan is developed specifically for Tina’s difficulty on breastfeeding. Out of the many concerns in the postpartum period, this is chosen since proper nutrition is essential for the infant for optimal growth and development, especially in the first few months of life, because brain growth proceeds at such a rapid rate during this time. During feeding, a parent is close to the infant, and a baby is apt to be particularly sensitive to the parent’s demonstration of affection or lack of warmth. An infant who does not experience a warm relationship with a mother may fail to thrive as surely as one who is denied sufficient protein or calories.             Tina and her parents have to be taught how to recognize signs of hunger in a newborn, including restlessness, tense body posture, smacking lips, and tongue thrusting. Otherwise, younger and new mothers usually wait for the infant to cry, and this is actually a late sign of newborn hunger. The teaching plan is designed for Tina yet it also requires cooperation from her parents. At 15 years old, Tina still isn’t mature enough to do things on her own and thus needs the guidance and support of her parents. Credit:ivythesis.typepad.com

Child Having a Child: A Teenage Pregnancy Case Study

Tina: Child Having a Child Adolescent pregnancy continues to be a major social challenge for the United States. It has the highest rat...

African American antenatal client with acute renal failure

Care for an African American antenatal client with acute renal failure   Definition: Antenatal care refers to care being given to the pregnant mother before birth. Antenatal care aims to monitor and promote the wellbeing of a mother and her developing baby. It includes the routine examination of the pregnant woman by an obstetrician, nurse practitioner, or certified nurse-midwife. Health promotion interventions are important during the antenatal period and can improve well-being of the woman and the fetus.   Assessment: Subjective: In the antenatal care of an African American pregnant woman, the nurses noticed that the woman had hemorrhage. Objective: Tests show inadequate renal perfusion due to fluid and electrolyte depletion or to hemorrhage.   Nursing diagnosis: Nursing diagnosis shows that the pregnant patient has acute renal failure. It is a clinical condition associated with rapid, steadily increasing azotemia, with or without oliguria. The causes of this are diverse and is still not clear in the case of the pregnant patient.       Implementation: All the possible consequences associated with each possible nursing action shall be considered in the implementation of the care for the client. The client may then need to adhere to the treatment modalities that are prescribed to her. Not only the pregnant patient should know about these, but the fami8ly of the pregnant patient should also be aware of this.   Evaluation: initial evaluation should seek reversible or specifically treatable causes of acute renal failure. Bladder neck obstruction is probably the most common cause of sudden, and often total, cessation of urinary output. The pregnant woman has a succeeding history of difficulty in voiding.   Clinical manifestations: The first sign of pregnancy is absence of an expected menstrual period. At this time, the pregnant woman may also notice breast engorgement with nausea and occasional vomiting. The breast engorgement is caused by increased levels of estrogen and progesterone. The urinary sediment is usually unremarkable but may contain white and red cells as well as casts.   Diagnostic studies: Pelvic examination at this time shows uterine enlargement compatible with pregnancy, and a slide agglutination test for urinary HSG usually will be positive. Other signs seen on diagnostic studies at this time are helpful. Three important signs of pregnancy are fetal heart tones, fetal movements, and identification of a fetal skeleton.  References     Credit:ivythesis.typepad.com

African American antenatal client with acute renal failure

Care for an African American antenatal client with acute renal failure Definition: Antenatal care refers to care being given to the ...

CASE STUDY ON ANTENATAL PREGNANCY

Pregnant women are sensitive as they pass on the most difficult part of their life like Della who was admitted to the antennal ward from the triage. As of her pregnancy, she had a lot of admissions for many reasons such as pain in the abdomen and fetal movements, her hydronephrosis and nephrostomy to the antennal ward by herself. So there must be an appropriate care that may be suitable to the case of Della; responsibility for deliveries should be taken into consideration by midwives as they will guide her during her pregnancy, delivery and postnatal period and the general practitioners who will record all the necessary information about her for the effective operation. Building relationship also to patients like Della is also essential aside from promoting primary health care. This will preserve and intensify the delivery, so as to address the potential delivery of the patient as well as the desired pregnancy and giving of birth. As a result of the cooperation of the health care people; through the skills they contribute and the discipline they think about, Della has been successful in giving birth Credit:ivythesis.typepad.com

CASE STUDY ON ANTENATAL PREGNANCY

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Care for an African American antenatal client with acute renal failure

Care for an African American antenatal client with acute renal failure   Definition: Antenatal care refers to care being given to the pregnant mother before birth. Antenatal care aims to monitor and promote the wellbeing of a mother and her developing baby. It includes the routine examination of the pregnant woman by an obstetrician, nurse practitioner, or certified nurse-midwife. Health promotion interventions are important during the antenatal period and can improve well-being of the woman and the fetus.   Assessment: Subjective: In the antenatal care of an African American pregnant woman, the nurses noticed that the woman had hemorrhage. Objective: Tests show inadequate renal perfusion due to fluid and electrolyte depletion or to hemorrhage.   Nursing diagnosis: Nursing diagnosis shows that the pregnant patient has acute renal failure. It is a clinical condition associated with rapid, steadily increasing azotemia, with or without oliguria. The causes of this are diverse and is still not clear in the case of the pregnant patient.       Implementation: All the possible consequences associated with each possible nursing action shall be considered in the implementation of the care for the client. The client may then need to adhere to the treatment modalities that are prescribed to her. Not only the pregnant patient should know about these, but the fami8ly of the pregnant patient should also be aware of this.   Evaluation: initial evaluation should seek reversible or specifically treatable causes of acute renal failure. Bladder neck obstruction is probably the most common cause of sudden, and often total, cessation of urinary output. The pregnant woman has a succeeding history of difficulty in voiding.   Clinical manifestations: The first sign of pregnancy is absence of an expected menstrual period. At this time, the pregnant woman may also notice breast engorgement with nausea and occasional vomiting. The breast engorgement is caused by increased levels of estrogen and progesterone. The urinary sediment is usually unremarkable but may contain white and red cells as well as casts.   Diagnostic studies: Pelvic examination at this time shows uterine enlargement compatible with pregnancy, and a slide agglutination test for urinary HSG usually will be positive. Other signs seen on diagnostic studies at this time are helpful. Three important signs of pregnancy are fetal heart tones, fetal movements, and identification of a fetal skeleton.    Credit:ivythesis.typepad.com

Care for an African American antenatal client with acute renal failure

Care for an African American antenatal client with acute renal failure Definition: Antenatal care refers to care being given to th...

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