1. Dylan is in her second trimester as she is 28 weeks pregnant and has come for a routine checkup. The six priority assessments that must be done on her include weight monitoring, a test on her glucose tolerance, fetal growth monitoring, a thyroid profile, a test on the complete blood found and a blood glucose screen (Leifer, 2019)
2. Four abnormal urine findings during pregnancy;
I) high protein levels to signify urinary renal impairment and preeclampsia
II) high levels of sugar might indicate gestational diabetes,
III) urine culture with bacteria could indicate urinary tract infection
IV) concentrated urine could also indicate hyperemesis gravidarum (Leifer, 2019).
3. Fundal height is measured using an inch tape where the distance between the symphysis pubis and the fundus is measured in centimeters (Haragan et al., 2015). Dylan’s 29 cm fundal height is normal.
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4. If there was an abnormal fundal height, the primary care provider would order an ultrasound to be done as a diagnostic test that will show the fetal length (Haragan et al., 2015).
5. A water-soluble gel is placed on the head of the doppler transducer while placing the earpieces on the ear and connecting them to the speaker. After locating the back of the fetus, the head of the transducer is placed at the fetal back, and the nurse counts the heartbeat while letting Dylan hear the heartbeat (Leifer, 2019)
6. A fetal heart rate of 130 bpm with regular rhythm and no deceleration for Dylan’s baby are a good sign because the normal fetal heart rate is between 120 and 140 bpm (Leifer, 2019). This normal rate is also characterized by regular rhythms, which is accounted for by the absence of the deceleration.
7. The physician knows that at this stage of the pregnancy, fatigue might be a normal occurrence (Harvey et al., 2016). However, the physician orders for a complete blood count to be done on Dylan because she constantly feels exhausted. The physician wants to find out if she has lesser hemoglobin which can lead to anemia (Leifer, 2019). The results will help them mitigate any risks that she and her child have (Harvey et al., 2016).
8. Dylan’s prenatal checkup shows that she is suffering from anemia. If these values are not corrected, she runs the risk of morbidity and could even result in her death. The impacts to the fetus are the risk of low birth weight, risk of premature birth, and in worst cases, scenarios, intrauterine death (Kaur, Kaur & Suri, 2020).
9. Based on these lab results, the primary care physician should write Dylan a prescription for ferrous sulfate injections, as this will help in improving her hemoglobin levels (Leifer, 2019). She should also get a prescription for vitamin supplements and folic acid that will ensure the child’s normal growth and prevent any birth defects from occurring (Leifer, 2019).
10. Dylan’s anemia is a cause of worry. I would, therefore, explain to her the severity of having anemia during pregnancy (Kaur, Kaur & Suri, 2020). I would further inform her of the importance of the medication to both her child and herself. Next, I will tell her about different foods rich in iron that she should consume. I would also caution her on discontinuing her medication and the risks that could arise (Kaur, Kaur & Suri, 2020). Finally, I would ensure that she understands her prescription and answer any questions she had in detail.
11. At the end of the appointment, I would provide the following priority teachings to Dylan:
I) Importance of adhering to her prescription,
II) The diet that she needs to adhere to,
III) Importance of following up on her hemoglobin increase,
IV) Medication advice (Leifer, 2019).
References
Haragan, A. F., Hulsey, T. C., Hawk, A. F., Newman, R. B., & Chang, E. Y. (2015). Diagnostic accuracy of fundal height and handheld ultrasound-measured abdominal circumference to screen for fetal growth abnormalities. American journal of obstetrics and gynecology, 212(6), 820-e1.
Harvey, T., Zkik, A., Auges, M., & Clavel, T. (2016). Assessment of iron deficiency and anemia in pregnant women: an observational French study. Women’s Health, 12(1), 95-102.
Kaur, J., Kaur S., H. & Suri, V. (2020). To study the prevalence of anaemia among pregnant women in north India: a cross sectional study. Indian Journal of Applied Research, 10(1 ).
Leifer, G. (2019). Introduction to Maternity & Pediatric Nursing . Elsevier Health Sciences.
