NRNP-6552 Week 8 Common Health Conditions with Implications for Women

Identify data provided in your chosen case and any additional data needed.

Objective findings.

Identify findings provided in your chosen case and any additional data needed.

Describe the rationalefor each test or intervention with supporting references.

Describethe rationales for your choice of each diagnosis with supporting references.

Describe rationales and supporting references for each.

Social Determinants of Heath (SDoH) for your chosen case.

Describe rationales and supporting references for each.

·         She delivered a 9 lbs viable male infant via spontaneous vaginal delivery in her first pregnancy after 10 hours of labor.

·         She denied any complications during the pregnancy, delivery, and postpartum.

·         There is a family history of diabetes in the paternalgrandfather and aunt and obesity in both parents.

Other additional information, I would also wish to know:

1.      If the patient has been experiencing polydipsia, excessive thirst, or polyuria.

2.      If the patient has had any prior diabetes mellitus screening (Sharma et al., 2022).

3.      If there was history of gestational diabetes mellitus in the first pregnancy.

4.      The gestation age at delivery in her first pregnancy.

·         Height-5’2”, Weight-170 lbs, and BMI-31.1.

·         Head and ENT examination had normal findings.

·         Supple neck without adenopathy and thyromegaly.

·         The lungs were eupneic and clear on auscultation bilaterally.

·         The CVS exam had RRR, soft systolic murmur Grade II/VI, no rubs noted, 2+ peripheral pulses, and no edema noted

·         The breasts were soft and had fibrocystic changes bilaterally but had no masses, dimpling, discharge, redness, or inflammation

·         An abdominal examination revealed uterine fundal height size of approximately 24 weeks’ gestation that is non-tender.

·         Fetal heart tones were present on auscultation with Doppler.

·         HbA1C levels to determine the patient’s prognosis.

·         Urinalysis to determine whether there are any proteins and pus cells in urine. This crucial in diagnosis of proteinuria and urinary tract infections in the current pregnancy (Nakshine et al., 2023).

·         Repeat blood pressure (BP) measurements after four hours to determine whether she is hypertensive as her previous BP reading was elevated (Chang et al., 2023).

·         Obstetric ultrasound to assess for placentation, fetal growth, anomalies, and placental blood flow.

·         Basic metabolic panel and liver function tests to detect renal and liver function and electrolyte abnormalities in a setting of underlying undiagnosed hypertension (Chang et al., 2023).

·         GDM is a condition characterized by insulin resistance due to placental hormones, resulting in glucose intolerance and hyperglycemia (Nakshine et al., 2023).

·         GDM is diagnosed following a positive OGTT test done  between the 24th and 28th week of gestation.

·         GDM risk factors in this patient include obesity, uncontrolled weight gain, family history of diabetes, and previous history of delivery of a large for gestation age neonate (Sharma et al., 2022)

Type 2 diabetes mellitus (T2DM)

·         An underlying undiagnosed T2DM is a possible diagnosis for the patient.

·         The risk factors for this patient include obesity, and a positive family history of diabetes (Raets et al., 2023).

Hypertensive disease in pregnancy

·         The patient has a sitting blood pressure of 140/84 mmHg.which is slightly elevated for a normal pregnancy at the second trimester.

·         An advanced maternal age, obesity, and an underlying diabetes mellitus also predispose the patient to hypertensive conditions, such as preeclampsia and gestational hypertension (Chang et al., 2023).

·         I would encourage weight loss measures, including regular exercise.

·         I would also offer nutritional advise where I would encourage the patient to take nutritious foods low in processed carbohydrates and sugar to ensure sugar control (Mukherjee et al., 2022).

·         I would also prescribe insulin 10 units subcutaneously OD.

·         I would also encourage regular blood sugar monitoring.

Hypertension

·         I would prescribe nifedipine 20 mg PO BD (Chang et al., 2022).

·         I would encourage weight loss, exercise, and nutritious diets.

·         I would also advise have regular BP monitoring.

For either:

·         I would encourage the patient to perform a non-stress test at the third trimester(Chahed et al., 2022).

·         Another key SDOH that is crucial in this patient is economic stability as management of GDM requires financial incentives due to the number of tests, follow-up visits, and medications required (Roustaei et al., 2023).

·         If either of the SDOH are inadequate, the patient is at risk of poor health outcomes due to the associated complications.

·         Maternal complications include: diabetic ketoacidosis, recurrent UTIs and vaginal fungal infections, neuropathies, preeclampsia, polyhydramnios, retinopathies, and nephropathy (Ye et al., 2022).

·         Neonatal and fetal complications includestill birth, neonatal hypoglycemia, macrosomia, hypothermia, jaundice, respiratory distress, and prematurity.

·         The patients are also at risk of developing overt type 2 diabetes if the blood glucose levels are poorly controlled and insulin resistance persists (Raets et al., 2023).

The referral is crucial to help tailor the patient’s treatment, including medicationsto meet the needs (Mukherjee et al., 2022).

2.      Maternal Fetal Medicine (MFM) Specialist

·         The referral allows close monitoring of the patient and her unborn child to minimize complications due to hyperglycemia or hypertension such as still birth (Sweeting et al., 2022).

·         In addition, the MFM can also perform specific tests, including non-stress test, Doppler ultrasound studies, and fetal growth monitoring, crucial in high-risk pregnancies.

·         They can also help plan for delivery of the neonate.

3.      Nutritionist

·         The referral is crucial for nutritional advise to empower the patient with appropriate diets she can take that would help in sugar control and weight loss (Mukherjee et al., 2022).

Patient Education

·         I would advise the patient on the importance on controlled blood sugars. As a result, I would advise her on weight loss, exercise, healthy diets, and medication adherence (Chahed et al., 2022).

·         I would also encourage the patient to have regular follow-up visits for close monitoring and inform her of certain pregnancy warning symptoms, such as vaginal bleeding, drainage of amniotic fluid, lower abdominal pains, and reduced or absent fetal movements.

·         I would also adviseher on the importance of regular blood sugar testing and recording for monitoring purposes.