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

High Risk Case Study # 4: Pregnant woman at risk for preterm labor

Background: Keisha is a 24-year-old unmarried multigravida (4-0-1-2-1) woman. She is 15 weeks pregnant and has finally come to the women's health clinic for her first prenatal visit since she is afraid she will have another premature baby. Her first two pregnancies resulted in miscarriages at 13 and 14 weeks. Her third pregnancy resulted in the birth of her 4-year-old daughter at 30 weeks’ gestation. Keisha smokes one pack of cigarettes every 1 to 2 days. Her health history reveals that she has been hypertensive since 20 years of age and often experiences bladder infections. Her stress level has increased since her boyfriend, the father of the baby, has started to “pick fights with her and hit her.” She cannot understand why he is doing this since he never hit her before when he would get angry.

Questions:

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

1. What risk factors associated with preterm labor and birth does Keisha's history reveal?

2. You recognize that violence has become part of Keisha's relationship with her boyfriend. How would you address this problem with her? Why is he “picking fights” with her when she is pregnant?

3. Keisha asks you what to look for in terms of signs that preterm labor is occurring. “With my daughter, everything seemed to happen so fast without any warning.” What should you teach Keisha about the signs of preterm labor and what to do if she detects them? Her obstetrician did a fetal fibronectin test and it was positive. What does this mean?

4. Keisha goes into labor at 24 weeks’ gestation. Due to her risk factors and some recent uterine contractions, Keisha is on home uterine monitoring (HUAM) and nursing telephone consultation has been arranged. How would you prepare Keisha for discharge? How about increasing the effectiveness of HUAM? What kind of life style modifications and activities would you recommend?

5. Keisha comes into the hospital in labor at 30 weeks gestation. She has pre-term premature rupture of the membranes (PPROM). She is given a dose of betamethesone. Why was given this medication? What tocolytic medication (there are a couple of possibilities!)?. How will it be used? She is also asked if she would like to transfer to UCSF or stay here. How would you facilitate her decision-making about transferring or staying put? What kind of information would you give her?

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!