A client, a 26-year old, arrives at the women’s clinic. She thinks she may be pregnant. She has experienced nausea and vomiting for the past month. She feels tired all the time and has trouble sleeping because she frequently has to get up in the middle of the night to urinate. Her last menstrual period (LMP) was six weeks ago. Her menstrual periods have always been regular, every 28 to 30 days. When asked about her past obstetrical history she states she had an elective abortion when she was 17 years old. She has no children. The client states she smokes 1 pack of cigarettes a day and has a few beers on the weekends with friends. She does not like to cook so most meals are take-out.
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The health care provider (HCP) does a pregnancy test and it is positive. Her physical exam confirms the pregnancy. An ultrasound is performed and the client is approximately 6-8 weeks pregnant. The patient is ecstatic about the pregnancy but has many questions. The HCP reviews the importance of prenatal care and informs the client of the scheduled visits needed and what will be done at each visit. Lab work is ordered and a consultation with a dietician is scheduled for next week.
1. List the three positive signs of pregnancy.
2. How would you calculate the client’s delivery date? Calculate the estimated date of birth (EDB) if the client states her last menstrual period was on January 17, 2014.
3. Identify the client’s obstetrical history using the GTPAL method?
4. List five expected changes that will occur during pregnancy.
5. What initial routine laboratory tests will be conducted?
6. At the initial prenatal visit what should the client expect? What should the client expect at ongoing prenatal visits?
7. List four common discomforts of pregnancy.
8. Name two potential complications this client should promptly report to the HCP.
9. What is the recommended weight gain during pregnancy?
10. What are the recommended nutritional guidelines during pregnancy?
An 8 year-old child is brought to the emergency room (ER) with a fractured right femur. The parents report that the child was playing baseball and while sliding into home plate, he collided with another player on the opposing team. The child requires surgery to repair the fracture. After surgery, the child will be in skeletal traction for two weeks and must remain on bedrest. Following skeletal traction, the child will be placed in a long leg cast.
Upon assessment, the vital signs are: Temp-37 C (98.6 F), pulse- 98 beats/minute, respirations-21 breaths/minute, and blood pressure-124/86 mm Hg. The child’s pain level is an “8” on a scale of 0-10. Swelling and bruising of the thigh is noted. An X-ray confirms the diagnosis. The child is frightened about going to the operating room.
The child has no known allergies and takes a multivitamin every morning. His passion is sports, especially baseball, and when he grows up in wants to be a professional baseball player and play for the New York Yankees.
Essay Paper Questions:
1. What can the nurse do to reduce the child’s fear of hospitalization?
2. According to Erikson, what psychosocial developmental stage is this child in?
3. What diversional activities can the nurse provide while the child is in skeletal traction to promote growth and development?
4. Following surgery, what assessment findings would cause the nurse to notify the health care provider (HCP)?
5. What is compartment syndrome? What are the findings of compartment syndrome?
6. What nursing actions should be taken when caring for a child in skeletal traction?
7. What is a primary nursing diagnosis related to the above case study?
8. After two weeks of skeletal traction, the child is placed in a long leg cast and is discharged. What discharge teaching should the nurse homework provide to the child and his parents regarding cast care?
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