N 340 Women's Health & Illness in The Expanding Family & N345 Clinical Practicum

High Risk Pregnancy Case Study # 5 Unplanned pregnancy with spotting

Background: Ruby is a 45 year old G4P2103 divorced woman. Her youngest child is 23 years old. Ruby is an art teacher at a local middle school. She had been having unusually heavy, irregular periods for approximately 6 months and her previous MD told her she was probably in "the change of life." She has not had a period for 3 months. During that time she has been fatigued and experiencing nausea and vomiting at least twice a day. She is 5'4" tall and weighs 140 pounds. Despite her nausea and vomiting, she thinks she has gained about 5 pounds in the last 3 months.

Visit today: She comes to your clinic today to get information on menopause and to find out why she is feeling so sick. You convince her that a pregnancy test would be a good idea and to her shock it comes back positive. Her physical exams revels a 16 week size uterus and a FHR of 148. She is also having some spotting. She is going to get into nursing school in the Spring and so has just finished her series of the HepB vaccine.

Please address the following: What is your Keystone nursing diagnosis (ND)? How did you pick this one? What are some other NDs?

Questions:
1. What is the most likely reason Ruby had heavy periods?

2. What are the risk factors associated with this pregnancy?

3. At this point in the pregnancy, what screening tests for congenital anomalies could be done?

4. What information could you use to try to determine Ruby's due date?

5. Ruby's uterus is bigger than how many weeks pregnancy she is. Name at least two possible reasons for this discrepancy.

6. Give some possible reasons for her spotting.

7. Are there risks associated with getting the HepB vaccine during pregnancy?

Your group will have 15 minutes to present what you deem to be the most pertinent information. You will then have 5 minutes for questions!