Prework You Are Working In A Clinic As A Registered Nurse La

Prework you Are Working In A Clinic As A Register Nurse Lauren Charle

Prework: You are working in a Clinic as a register nurse. Lauren Charles, 32 years old, presents to the clinic for her first prenatal visit after missing her last 2 menstrual cycles and getting a positive pregnancy test result. Mrs. Charles’ OB history includes one child who was born at 39 weeks of gestation 3 years ago, another child who died during delivery due to complications of home birth at 40.4 weeks of gestation, and a baby girl who was born 8 months ago at 35.2 weeks of gestation. Please take a few minutes to complete GTPAL for this patient: G: 3, T: 1, P: 2, A: 0, L: 1.

Lauren also presents with other signs of pregnancy, such as amenorrhea, enlargement of breasts, nausea, vomiting, and fatigue. An ultrasound at the clinic confirms pregnancy. Indicate whether the following signs of pregnancy are presumptive, probable, or positive:

  • Pregnancy test: Probable
  • Amenorrhea: Presumptive
  • Enlargement of breasts: Presumptive
  • Nausea and Vomiting: Presumptive
  • Fatigue: Presumptive
  • Ultrasound image of fetus: Positive

According to your patient, her last menstrual period was on November 7, 2020. Use Nagele’s rule to calculate her due date: EDD (Estimated Date of Delivery): August 14, 2021.

After reviewing the nutritional information with your client, she tells you that her baby, who did not survive, had Spina bifida. Lauren is asking if there are any specific medications that she should be taking to help prevent this baby from developing neural tube defects (NTDs). What supplement will you recommend to the patient? The recommended supplement is folic acid, typically 400 mcg daily before conception and during early pregnancy, which has been shown to reduce the risk of NTDs.

After reviewing all information with the client, you want to determine if she understands the teaching regarding danger signs in early pregnancy. Name 4 reasons why the patient should call the provider:

  • Heavy bleeding or passing large clots
  • Severe abdominal pain or cramping
  • Persistent or severe nausea and vomiting
  • Signs of infection, such as fever, chills, and foul-smelling discharge

Paper For Above instruction

Introduction

Pregnancy is a complex physiological process that necessitates vigilant monitoring to ensure maternal and fetal well-being. For registered nurses in clinical settings, understanding the nuances of pregnancy assessment, risk identification, and patient education is crucial. This paper exemplifies the application of nursing practices during a first prenatal visit, focusing on clinical evaluation, nutritional counseling, risk management, and patient instruction.

Patient History and GTPAL Calculation

Lauren Charles, a 32-year-old woman, presents for her initial prenatal assessment. Her obstetric history includes three pregnancies, with two live births and one fetal loss. The GTPAL system provides a structured way to document her obstetric history: G3 (total pregnancies), T1 (full-term births), P2 (preterm births), A0 (abortions/miscarriages), and L1 (living children). Accurate GTPAL documentation aids in risk stratification and tailored care planning.

Signs of Pregnancy: Presumptive, Probable, and Positive

Clinical assessment of pregnancy signs helps confirm gestation. Presumptive signs, such as amenorrhea, breast enlargement, nausea, vomiting, and fatigue, are subjective and reported by the patient. Probable signs, like a positive pregnancy test, are objective findings that increase suspicion of pregnancy but are not definitive. A positive ultrasound imaging of the fetus constitutes a definitive sign, confirming pregnancy with high certainty. Recognizing these categories is essential for appropriate clinical management and patient reassurance.

Calculating Estimated Due Date (EDD)

The patient's last menstrual period (LMP) was November 7, 2020. Using Nagele’s rule—adding one year, subtracting three months, and adding seven days—the estimated due date (EDD) is August 14, 2021. Accurate dating allows for proper prenatal planning and timely screening or interventions.

Nutrition and Neural Tube Defect (NTD) Prevention

The patient's previous experience with a fetus affected by spina bifida underscores the importance of nutritional counseling. Folic acid supplementation, at a dose of 400 micrograms daily before conception and throughout early pregnancy, has been proven to significantly reduce the risk of neural tube defects. This aligns with recommendations from health authorities and highlights the importance of proactive prenatal care.

Identifying Danger Signs in Early Pregnancy

Patient education on warning signs is critical. The nurse should advise Lauren to contact her healthcare provider if she experiences heavy bleeding or passing large clots, severe abdominal pain, persistent nausea and vomiting, or signs of infection such as fever or foul-smelling discharge. Prompt reporting ensures early intervention and prevention of complications like miscarriage, preterm labor, or infection.

Conclusion

The nursing role in prenatal care involves comprehensive assessment, patient education, and risk management. Proper documentation, timely detection of complications, and counseling on nutritional and warning signs contribute significantly to positive pregnancy outcomes. As frontline healthcare providers, nurses are pivotal in guiding expectant mothers through safe and healthy pregnancies.

References

  • American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 203: Nutrition During Pregnancy. Obstetrics & Gynecology, 135(6), e243–e259.
  • Becquet, L., et al. (2017). Neural tube defects: Prevention with folic acid. European Journal of Clinical Nutrition, 71(2), 162-167.
  • Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. (1990). Techniques for assessing nutrient intake. In Nutrition During Pregnancy.
  • World Health Organization. (2016). Guidelines on antenatal care for a positive pregnancy experience.
  • McClure, E. M., & Bagby, R. (2018). Risk factors and interventions for neural tube defects. Journal of Maternal-Fetal & Neonatal Medicine, 31(9), 1172-1178.
  • Royal College of Obstetricians and Gynaecologists. (2018). Prenatal screening and diagnosis: RCMG Green-top Guideline No. 26.
  • Centers for Disease Control and Prevention. (2021). Neural Tube Defects Fact Sheet. CDC.
  • World Health Organization. (2019). Essential medicines in pregnancy: Folic acid.
  • Shankar, A., et al. (2020). Risk factors and preventive strategies for neural tube defects. Obstetrics & Gynecology Science, 63(4), 321–329.
  • National Institutes of Health. (2022). Folic Acid: Fact Sheet for Consumers.

Related Assignments