Question Answered step-by-step O SEMINAR #4 – Nutrition/Oxygenation/Elimination 1. DATA COLLECTION… O SEMINAR #4 – Nutrition/Oxygenation/Elimination1. DATA COLLECTION History of Present Problem- L.D. is a 29-year-old Latina service woman who is 29 weeks gestation in the United States Navy. She has been working at a naval base in Virginia since her transfer from a naval vessel during this pregnancy. L.D. began prenatal care late at approximately 22 weeks and has had regular prenatal care since then from the nurse midwife stationed at the base hospital. She is at the provider’s office for a prenatal visit, and had her 28 week labs last week. Medical/OB History: L.D. is G3 P0020 (2 therapeutic abortions). She is 5 feet, 6 inches tall and her pre-pregnancy weight was 107 lbs. She currently weighs 115 lbs. and has gained about 8 lbs. so far in this pregnancy. Social History: L.D. is a single woman. She quit smoking when she discovered she was pregnant but smoked one-half pack of cigarettes a day until then. She works in an office, managing inventory and supplies for the base. She denies substance use. Her mother and siblings live in Southern California.Are these LAB TEST w/ RESULT High/Low/WNL?Hemoglobin- 9.1 grams (28 wks) Hematocrit – 30.8 % (28 wks) Type and RH – B+ (28 wks) Rubella – Immune (22 wks) 1hr glucose – 101 (28 wks) RPR- negative (22 wks) HIV -negative (22 wks) What data from the medical and OB histories above is important & RELEVANT?What are RELEVANT Data from OB & Medical Histories: what are the Clinical Significance: What is her most significant risk factor at this time? RELEVANT Data from Social History: Clinical Significance:2. Current Plan of Carea. What nursing/medical interventions would you prioritize for L.D. related to her 28 week lab results? Be specific regarding medications, diet, activity, testing, and other measures. Include any relevant cultural factors. b. During this prenatal visit L.D.’s BP is 108/72, her fundus measures 26 cm, her FHR is 114, and her urine dipstick shows trace protein and a large amount of WBC’s. Are any of these assessments abnormal, and if so, what interventions are appropriate? Yes they are abnormal protein in the urine could be an indication of pre eclampsia. A large amount of wbc could indicate an infection.3. UPDATE TO CLINICAL INFORMATION:Several weeks L.D. calls her provider’s office complaining of irregular contractions, approximately 1-2 contractions every 5 -10 minutes. L.D. is advised to go to the OB triage unit at the base hospital to be evaluated. a. What risk factors does this client have for preterm labor?Today’s Physical Exam: L.D.’s cervix is 3/60%, station -2; contracting q 5 minutes, and contractions are mild. Membranes are intact. Fetal Heart tones are in the 130s. Urine protein and glucose are negative. Fundal Height is 33 cm. Gestational age is calculated to be 34 5/7 using LMP and most recent ultrasound from three weeks ago. Vital signs: HR-96, R-18, B/P 108/74. T-97.8, FHR 138, weight 119lbsa. Is this client in preterm labor? Validate your answer using the client’s assessments and criteria for preterm labor.b. Describe nursing and medical interventions likely to be included for this client. Discuss whether each of the following is appropriate and if so how it will be implemented Activity restrictions IV fluids Laboratory testing Medications, Tocolytics and Glucocorticoids FHR monitoring Maternal VS monitoring Cervical monitoring Transfer to a Level 3 facilityc. Briefly explain some of the complications that L.D.’s newborn would be at risk for if the baby is delivered at this gestational age. Be sure to include critical effects on the neonate’s body systems. 4. UPDATE TO CLINICAL INFORMATION: L.D. is discharged from the hospital three days later after hydration lactated ringers and continuous fetal monitoring, a magnesium sulfate infusion, and betamethasone injections. She is scheduled for a primary C Section approximately 4 weeks later for a breech presentation discovered while she was hospitalized. a. What pre op interventions would you expect the admitting nurse in the OB unit to institute for L.D.?b. What are the unique maternal risks of a C Section and what interventions should be initiated post op by the nurse to help mitigate these risks?c. What are the unique neonatal risks of a C Section and what interventions should be initiated post op by the nurse to help mitigate these risks? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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