You are a registered nurse (RN) working in a Womenâ€™s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jonesâ€™s medical and obstetrical history is as follows.
Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papilloma virus (HPV), colposcopy within normal limits
Medical history: Chronic hypertension (HTN) x 5 years;
- (+) tobacco, â€œoccasionalâ€ per client (pt), <5 per/day currently, has smoked â€œoff and onâ€ for 15 years
- (+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use
- Abusive partner with first pregnancy, states she has a new partner x 4 years
- Depression, currently not taking meds for treatment (tx)
Medications: Prenatal vitamins; Labetalol 200mg BID;
Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)
Write a two to three-page analysis of this scenario that answers the following questions:
- What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression?
- Document the considerations of yourself as the professional nurse in regards to self-awareness; be aware of attitudes, values and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.
- What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?
- What concerns should be discussed with Ms. Jones before she leaves her appointment?