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Betty

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Betty’s Unfolding Case

Betty is a 20 year old single black female. She has never been pregnant, and she does not have a history of any health conditions. Her family history includes HTN on her father’s side (PGF and F). Her MGM had breast cancer, and is now deceased. She does smoke, but states that she plans to quit when she stops being so “stressed out from school”. She presents in the health clinic complaining of a foul-smelling vaginal discharge. Which questions would you ask to elicit thorough information about her history?

What is the likely cause of the discharge?

Which tests do you anticipate?

Treatment options?

Teaching for Betty?

Betty has now graduated from college, and plans to marry the man of her dreams. She is 24 years old, and has not developed any new medical conditions. She is not ready for children yet, but wants to explore birth control options now that she is monogamous. Explain Betty’s options.

Now Betty presents to the clinic in tears. She forgot to replace her vaginal birth control ring, and realizes that she ovulated last night just after having intercourse with her husband. Betty is upset, because she is not ready to have a baby. She is starting a new internship, and wanted to delay childbearing for a little longer. What are Betty’s options?

Betty discussed her options with her husband, Frank, and they both agreed that they would just “wing it” and see what happens this month. Frank grew up in the Catholic Church in Honduras, and he believes that any medication that impedes implantation might be a violation of his religious practice. What is the appropriate nursing response?

Now it has been 2 months, and Betty has not had a period. She presents in the office requesting a pregnancy test. In which way does a pregnancy test detect pregnancy?

Betty’s test is positive. GTPAL? _____________

Her last menstrual period was 3/10/08. What is her EDC?___________________

Betty seems to be a little unsure about the pregnancy. She says that it is not great timing, but she has thought it through, and she is sure it will work out. As far as adjustment goes, what do you recognize is occurring at this stage of her pregnancy? What is the appropriate nursing response?

Since this is Betty’s first prenatal visit, which labs will likely be drawn?

Betty asks how often she should come to the office, and if her eating habits should be altered. Which advice can you give to Betty?

Betty also conveys that she is an athlete, and does not want to give up her daily workouts. What are the guidelines for exercise during pregnancy?

List any other appropriate prenatal teaching for the initial prenatal appointment.

Betty is here for her prenatal visit. She is 21 weeks pregnant, and thinks that she felt fetal movement last night. Her husband thinks it is too early, and she probably just felt gas. What can you tell Betty about fetal movement?

What is the term for fetal movement?

Now Betty’s exam begins. She is 24 weeks, and her uterus if measuring 28 cm. What does the nurse suspect?

Betty is sent for her glucose test. The results indicate that Betty needs further testing. Which test is used to detect gestational diabetes, and what are the parameters? Please give Betty instructions for the morning of the test.

Just as we suspected, Betty has gestational diabetes. The nurse provides her with some educational information, and makes an appt. for her to meet with the diabetes educator. Betty is tearful, and states that she does not want to take insulin. What is the best nursing response?

Betty has done well with the gestational diabetes. She is compliant with her diet and follow-up appts. She presents this morning at 31 weeks, and you notice that she is wearing “flip-flops” and no jewelry. She states that she cannot wear her wedding ring anymore, despite her healthy diet, she is so swollen. Betty’s BP is 149/99. What is the best nursing intervention?

Betty’s urine shows 2+ protein. Betty is sent to the hospital for a non-stress test, and 24- hour urinanalysis. What are the parameters for these tests?

NST:

24 hour urine analysis:

Betty’s 24 hour urine results and non-reactive stress test indicate that she needs to be admitted to the hospital. The doctor orders a Biophysical Profile. What is this?

In the meantime, Betty’s BP is now 167/105 on her left side. She has +3 lower DTRS and 1 beat of clonus bilaterally. She has developed a “blinding headache”. Which laboratory studies do you anticipate?

Betty’s lab results are still pending, but the physician starts her on Magnesium Sulfate. Nursing education for Magnesium Sulfate?

The initial bolus is a 4gm load, and the maintenance dose is 2gms/hr. Betty complains that her IV is hurting. What is the best nursing response and intervention?

Now Betty’s labs are back, and her ALT/AST is elevated. Her platelets are 89000. The physician orders Celestone IM x 2 doses. Explain to Betty why you are giving her this medication.

It is the next morning, and Betty is going to the OR for a Cesarean Section. The baby had late decelerations this a.m. Explain to Betty why she must be under general anesthesia?

Betty’s delivery resulted in a male infant weighing 4 lbs. His Apgar scores were 3 and 6. How do you determine Apgar scores?

Baby boy is transferred to the NICU. He is intubated because he has periods of apnea, and cannot maintain his oxygen saturation. He is grunting and retracting. What is his probable diagnosis? What is the anticipated plan of care for this baby?

What are some other common complications of prematurity?

Now the baby is 1 day old, and is stable in the NICU. Betty is recovering from her cesarean, but wonders why she still has to be on the Magnesium Sulfate. What is the best explanation??

Betty is 2 days postop now- her BPs are stable. The MgSO4 has been dc’d and she wants to see the baby in the NICU. What anticipatory guidance can you give?

The neonatal NP encourages Betty to pump for the baby even though she did not plan to breastfeed. What is the rationale?

The lactation consultant is not available, and Betty asks for instructions on the breast pump. Which advice can you give when Betty is concerned because she only has a small amount of “milk”? How often should Betty pump?

How can you advise Betty about milk storage?

What instructions can you give Betty to help her avoid contaminating her breast milk?

Now Betty has been pumping for 2 weeks. The baby is doing well in the NICU on CPAP and Betty is holding him for the first time. She notices that it hurts when she places him on her chest. Betty hands the baby off to her husband, and goes to examine her breasts. She finds a small lump near her right nipple. It is tender and feels like a little pea. Betty calls you to the restroom crying. She states that she “has been through so much, and now she has breast cancer. “ How can you educate Betty? What is going on with her?

How can Betty treat her condition?

Now Betty comes to the office for her 6 week postpartum checkup. She has healed well, and continues to pump breastmilk for the baby. She states that she does not want birth control because she is pumping so she can’t get pregnant. How can you educate Betty? What are her options?

Betty begins to cry during her appointment and says that she feels “so worthless, and can hardly get out of bed to take a shower”. What do you suspect? What questions should you ask? How can you intervene?

Now Betty is taking baby boy home. He weighs 5 lbs 14 oz, and only has supplemental oxygen. The neonatal NP told Betty to avoid crowds for now. Betty does not understand why. Explain the rationale for the instructions. What are premature infants at risk for? Which additional immunization will be necessary?

Betty has been doing pretty well at home. She does take an antidepressant, and attends a support group for families with premature infants. ECI comes to their house to work with the baby boy, who shows signs of some neurological impairment. Betty and her husband do not want any more children. She asks about her options for sterilization. How can you advise her?

What is a tubal ligation?

What is a vasectomy?

When is the vasectomy considered effective?

Betty presents for her annual exam, one year to the day of her baby’s birth. Her husband has gone ahead with the vasectomy, and their relationship is going well. Betty reports that she has had a couple of lumps that appear every month on both breasts. They are painful, but seem to subside after her period. List the education topics for Betty.

Betty is still worried about the lumps. What would make her a candidate for a mammogram?

Betty’s mammogram was fine. How often should she get mammograms after this?

Betty and Frank and baby boy are doing well. Baby boy wears glasses, and has developmental delay. Betty and Frank have utilized their resources well, and currently lead a support group for parents of NICU infants.

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