Nursing care interventions for clients during pregnancy, labor, and birth.

    Scenario You are a registered nurse (RN) working in a Women’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. Jones’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; Allergies: Penicillin Social history: • (+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” 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) Instructions Write a three-page analysis of this scenario that answers the following questions: 1. What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression? 2. 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. 3. What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth? 4. What concerns should be discussed with Ms. Jones before she leaves her appointment?

Sample Solution

   

When caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases (STDs), and depression, there are a number of important factors to consider.

Domestic abuse

Domestic abuse is a serious problem that can have a profound impact on both the victim and their health. Victims of domestic abuse are often at increased risk for a number of health problems, including physical injuries, mental health problems, and substance abuse.

Full Answer Section

   

When caring for a victim of domestic abuse, it is important to create a safe and supportive environment. The nurse should let the client know that they are not alone and that there are people who can help. The nurse should also assess the client's safety and risk of further abuse. If the client is at risk of harm, the nurse should develop a safety plan with the client.

Drug use

Drug use can also have a significant impact on a person's health. People who use drugs are at increased risk for a number of health problems, including overdose, infection, and mental health problems.

When caring for a client who uses drugs, it is important to assess the client's drug use history and current drug use. The nurse should also assess the client's risk for overdose and other complications. The nurse should also educate the client about the risks of drug use and the available treatment options.

Sexually transmitted diseases

STDs are a common problem that can affect people of all ages. STDs can cause a variety of health problems, including infertility, chronic pain, and even death.

When caring for a client with an STD, it is important to assess the client's sexual history and risk factors for STDs. The nurse should also test the client for STDs and provide treatment if necessary. The nurse should also educate the client about how to prevent STDs.

Depression

Depression is a common mental health problem that can have a significant impact on a person's life. Depression can cause a variety of symptoms, including sadness, fatigue, changes in appetite, and difficulty sleeping.

When caring for a client with depression, it is important to assess the client's depressive symptoms and risk factors for depression. The nurse should also provide the client with support and education about depression. The nurse may also refer the client to a mental health professional for further evaluation and treatment.

In addition to the above considerations, the nurse should also:

  • Build a trusting relationship with the client. This is essential for providing effective care.
  • Be patient and understanding. The client may be dealing with a lot of difficult emotions.
  • Be non-judgmental. The client may feel ashamed or embarrassed about their history of abuse, drug use, STDs, and depression.
  • Coordinate care with other members of the healthcare team. This may include doctors, social workers, and mental health professionals.

Here are some specific examples of what the nurse can do to care for a client with a history of domestic abuse, drug use, STDs, and depression:

  • Domestic abuse:
    • Assess the client's safety and risk of further abuse.
    • Develop a safety plan with the client if necessary.
    • Connect the client with resources for victims of domestic abuse, such as shelters and support groups.
  • Drug use:
    • Assess the client's drug use history and current drug use.
    • Assess the client's risk for overdose and other complications.
    • Educate the client about the risks of drug use and the available treatment options.
    • Refer the client to a substance abuse treatment program if necessary.
  • Sexually transmitted diseases:
    • Assess the client's sexual history and risk factors for STDs.
    • Test the client for STDs and provide treatment if necessary.
    • Educate the client about how to prevent STDs.
  • Depression:
    • Assess the client's depressive symptoms and risk factors for depression.
    • Provide the client with support and education about depression.
    • Refer the client to a mental health professional for further evaluation and treatment if necessary.

It is important to remember that every client is different and that there is no one-size-fits-all approach to care. The nurse should tailor their care to the individual needs of the client.

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