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NRNP-6552 WEEK 9 Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice

NRNP-6552 WEEK 9 Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice

Description of the Case Chosen:

 

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  • Case 4:

 

Outline Subjective data.

 

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

 Outline

Objective findings.

 

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

 Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

 Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

 Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

 Explain key

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

 Describe collaborative care referrals and patient education needs for your chosen case.

 

Describe rationales and supporting references for each.

 
·         A 16-year-old Caucasian G1P0, presents with a complain of missing her period for two months despite a normal cycle.

·         She is sexually active with her boyfriend and they do not use condoms as they use withdrawal method as birth control.

·         Her urine pregnancy test in clinic today is positive and in the past two weeks, she has been having daily nausea, vomiting, and dysuria.

·         She has previously treated for chlamydia and gonorrhea earlier this year and unsure whether the boyfriend was treated. However, she had a normal pap smear but has not received a HPV vaccine.

·         She attained menarche when she was 12 years, her cycle is regular lasting for seven days where she uses two tampons a day.

·         She is in high school and is about to enter the 11th grade and lives with her grandmother and two older siblings. She also smokes a pack of cigarettes a day.

 ·         Vital signs: BP-110/68, P-80, RR-18, T-37.1 Weight-110 lbs.

·         A pelvic exam reveals:

i)                   Cloudy and yellow mucoid cervical discharge on speculum.

ii)                 The cervix had a friable appearance with cervical motion tenderness (CMT).

iii)               On bimanual examination revealed an eight-week size uterus.

 

Urinalysis revealed 2+ ketones, 2+ nitrates, and 3+ leukocytes.

 An obstetric ultrasound to confirm and date the pregnancy and identify placentation and type of gestation (Amponsah-Tabi et al., 2022).

 

Microscopy, culture, and sensitivity (MCS) for cervical discharge: To identify the etiological agent for the abnormal discharge (Bansal et al., 2022).

 

Nucleic Acid Amplification Test (NAAT) for the cervical discharge to identify the causative agent for the abnormal cervical discharge (Dionne-Odom et al., 2020).

 

MCS for urine: To identify the organism responsible for the dysuria and abnormal urinalysis results (Corrales et al., 2022).

 

Sexually Transmitted Infections (STIs) screen: To exclude other STIs including hepatitis B, HIV, herpes, and syphilis, as the patient is high risk for STIs (Bansal et al., 2022).

 

Other antenatal profile tests: They include complete blood count, blood grouping, and random blood sugar. This tests are recommended for all pregnant women as part of antenatal care (Amponsah-Tabi et al., 2022).

 First trimester pregnancy:

·         Maria has a two-month history of amenorrhea. In addition, a pelvic examination revealed an eight-week size uterus.

·         She has been sexually active and not using an efficient contraceptive method.

·         She is also experiencing some early pregnancy symptoms including nausea, vomiting, and vaginal infections (Ertmann et al., 2022).

 

Cervicitis:

·         Cervicitis is an inflammatory condition of the cervix caused by STIs, such as gonorrhea and chlamydia (Dionne-Odom et al., 2020).

·         The patient is at high risk for STIs as she has a previous history of gonorrhea, the partner’s treatment status is unknown, and she has not been using any barrier method during coitus.

·         Patients with cervicitis often have a mucopurulent cervical or vaginal discharge and abnormal cervical appearance, including ectropion, friability, motion tenderness (Bansal et al., 2022).

·         Other symptoms include splash dysuria, urethral discomfort, vulvar or vaginal itch, or lower abdominal pain.

 

 

Urinary Tract Infection (UTI):

·         The patient is at experiencing one of the most common symptoms of UTI, dysuria (Corrales et al., 2022).

·         In addition, the urinalysis revealed presence of nitrates and leukocytes that are characteristic to UTIs.

 First trimester pregnancy:

·         Iron 27 mg/day PO and folic acid 600mcg PO OD supplements (Amponsah-Tabi et al., 2022).

·         Book the patient for an antenatal clinic (ANC) visit for regular follow-up clinics.

 

Cervicitis:

·         Ceftriaxone 1g IV OD.

·         Azithromycin 500 mg PO OD for three days (Dionne-Odom et al., 2020).

·         Request the patient for follow-up to ensure the infection is fully treated.

 

UTI:

Nitrofurantoin 100 mg PO BD for seven days (Corrales et al., 2022).

 ·         SDoH essential for Maria include access to healthcare facilities and educational materials, living status, and financial status.

·         Maria currently lives with her grandmother and two older siblings who may offer her emotional and financial support, thus allowing her to access good healthcare services (Phongluxa et al., 2020).

·         However, the living status may also provide a negative environment for Maria poor living standards.

·         It is also crucial to note that Maria is a teenager and in high school, thus making her at risk of stigmatization due to teenage pregnancy. As a result, this may make her avoid visiting healthcare facilities to avoid the stigma, thus neglecting her antenatal health (Girardi et al., 2023).

·         Maria is also unemployed and with limited financial resources which limits her from accessing healthcare facilities or other resources due to financial constraints.

 Obstetricians:

·         The referral is crucial in regular monitoring of the patient’s antenatal, natal, and postnatal care.

·         They are also crucial in primary and secondary prevention of several complications associated with teenage pregnancies including preeclampsia, anemia, and obstetric hemorrhages (Diabelková et al., 2023).

·         They can also educate her on contraception, STIs, and safe sexual practices.

 

Adolescent psychologists:

·         The psychologists are crucial in assessing Laura’s mental health during this period characterized by psychological stress due to pregnancy and abandonment by the boyfriend (Ntshayintshayi et al., 2022).

·         The psychologist can also help Maria develop coping strategies that can help her during her pregnancy and afterwards.

 

Nutritionist:

·         The referral is crucial in ensuring Maria’s diets are good to meet the nutritional requirements for her pregnancy (Diabelková et al., 2023).

 

Community Social Worker:

·         The referral would help in evaluating Maria’s living and education status (Ntshayintshayi et al., 2022).

·         They can also help her find useful resources that would help Maria in her current state.

 

Patient Education

·         It is crucial to educate Maria on STIs, the risk and protective factors, and the importance of treatment.

·         It is also crucial to educate her on the importance of attending the ANC to ensure a healthy pregnancy (Groenewald et al., 2023).

·         I would encourage Maria to quit pregnancy and avoid using alcohol or any other drugs during her pregnancy to avoid fetal, neonatal, or early childhood complications, such as fetal alcohol syndrome.

·         I would also inform her of certain danger signs in pregnancy, such as vaginal bleeding, abdominal pain, and drainage of amniotic fluid.

 

 

References

Amponsah-Tabi, S., Dassah, E. T., Asubonteng, G. O., Ankobea, F., K. Annan, J. J., Senu, E., Opoku, S., Opoku, E., & Opare-Addo, H. S. (2022). An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana. PLoS ONE, 17(10). https://doi.org/10.1371/journal.pone.0275933

Bansal, S., Bhargava, A., Verma, P., Khunger, N., Panchal, P., & Joshi, N. (2022). Etiology of cervicitis: Are there new agents in play? Indian Journal of Sexually Transmitted Diseases and AIDS, 43(2), 174-178. https://doi.org/10.4103/ijstd.ijstd_75_21

Corrales, M., Corrales-Acosta, E., & Corrales-Riveros, J. G. (2022). Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines. Journal of Clinical Medicine, 11(23). https://doi.org/10.3390/jcm11237226

Diabelková, J., Rimárová, K., Dorko, E., Urdzík, P., Houžvičková, A., & Argalášová, Ľ. (2023). Adolescent Pregnancy Outcomes and Risk Factors. International Journal of Environmental Research and Public Health, 20(5). https://doi.org/10.3390/ijerph20054113

Dionne-Odom, J., & Marrazzo, J. (2020). Cervicitis: Balancing the Goals of Empiric Therapy and Antimicrobial Stewardship to Improve Women’s Health. Sexually Transmitted Diseases, 47(6), 387. https://doi.org/10.1097/OLQ.0000000000001183

Ertmann, R. K., Nicolaisdottir, D. R., Kragstrup, J., Overbeck, G., Kriegbaum, M., & Siersma, V. (2022). The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth. Acta Obstetricia et Gynecologica Scandinavica, 102(1), 33-42. https://doi.org/10.1111/aogs.14474

Girardi, G., Longo, M., & Bremer, A. A. (2023). Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. International Journal for Equity in Health, 22. https://doi.org/10.1186/s12939-023-01963-x

Groenewald, C., Isaacs, N., & Qoza, P. (2023). Hope, agency, and adolescents’ sexual and reproductive health: A mini review. Frontiers in Reproductive Health, 5. https://doi.org/10.3389/frph.2023.1007005

Ntshayintshayi, P. N., Sehularo, L. A., Mokgaola, I. O., & Sepeng, N. V. (2022). Exploring the psychosocial challenges faced by pregnant teenagers in Ditsobotla subdistrict. Health SA Gesondheid, 27. https://doi.org/10.4102/hsag.v27i0.1880

Phongluxa, K., Langeslag, G., Jat, T. R., Kounnavong, S., Khan, M. A., & Essink, D. R. (2020). Factors influencing sexual and reproductive health among adolescents in Lao PDR. Global Health Action, 13(Suppl 2). https://doi.org/10.1080/16549716.2020.1791426

 

 

 

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Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice

The Assignment for this week is to provide you an opportunity to analyze one of four case studies provided.  These case studies involve common pregnancy and psychosocial issues encountered in advanced nursing primary care practice. You will use the case study template under weekly resources to develop your assignment.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

 

Learning Resources

Required Readings

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.
    • Chapter 3,” Women’s Growth and Development Across the Life Spans) pp. 39–49)
    • Chapter 13, “Contraception” (pp. 236–266)

Adult Gerontology Resources

Clinical Guideline Resources

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC – for zika in pregnancy, etc.).

Required Media

Optional Resources

Note: In Weeks 1-10, these resources are optional for your review. In Week 11, you will be required to review each of the PowerPoint slides from the text Gynecologic Health Care (4th ed.).

To prepare:

  • Review the 4 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.
  • Review the Learning Resources for this week.
  • Use the Assignment Template found in the Learning Resources to complete your assignment.

Assignment:

You will submit your assignment using the case study template provided. If the assignment is not submitted using the case study template, it will not be graded.

By Day 5 of Week 9

Submit your case study assignment by Day 5 of Week 9.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as Wk9Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6552_Week9_Case_Study_Assignment_Rubric

NRNP_6552_Week9_Case_Study_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies.
30 to >26.7 ptsExcellent

The response provides clear, complete, and comprehensive descriptions of subjective and objective case data, appropriately outlining all diagnostic tests, clinical procedures and pharmacological interventions.

 26.7 to >23.7 ptsGood

The response provides clear, complete partial descriptions of the components of the subjective and objective case data, appropriately outlining most of the diagnostic tests, clinical procedures and pharmacological interventions.

 23.7 to >20.7 ptsFair

The response provides some components of the subjective and objective case data, but they are incomplete, vague or inaccurate, outlining some of the diagnostic tests, clinical procedures and pharmacological interventions.

 20.7 to >0 ptsPoor

The response provides unclear or incomplete components of subjective and objective case data. The diagnostic tests, clinical procedures and pharmacological interventions are missing, incorrect, or inappropriately applied.
30 pts
This criterion is linked to a Learning OutcomeIdentifies differential diagnoses related to case studies.
30 to >26.76 ptsExcellent

The response contains at least 3 differential diagnoses relevant and applicable to the case.

 26.76 to >23.7 ptsGood

The response contains at least 2 differential diagnoses relevant and applicable to the case.

 23.7 to >20.7 ptsFair

The response contains at least 1 differential diagnosis relevant and applicable to the case.

 20.7 to >0 ptsPoor

The response contains few or no differential diagnoses and/or diagnoses are not relevant and applicable to the case.
30 pts
This criterion is linked to a Learning OutcomeFormulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan.
30 to >26.76 ptsExcellent

Formulates a thorough treatment plan including explanations of appropriate diagnostic tests and treatment options. Fully incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources, with no less than 75% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

 26.76 to >23.7 ptsGood

Formulates a partially complete treatment plan including partial explanations of appropriate diagnostic tests and treatment options. Somewhat incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources with no less than 50% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

 23.7 to >20.7 ptsFair

Formulates a minimally complete treatment plan including incomplete or vague explanations of appropriate diagnostic tests and treatment options. Lacking in synthesis of knowledge gained from the resources for the module and current credible sources. Supported by at least 2 current peer- reviewed, references or professional practice guidelines.

 20.7 to >0 ptsPoor

Formulates a treatment plan that contains incomplete explanations of appropriate diagnostic tests and treatment options and/ or explanations are missing. Lacks synthesis gained from the resources for the module and current credible sources. Supported by 1 or no current peer- reviewed, references or professional practice guidelines.
30 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation
5 to >4.45 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors.

 4.45 to >3.95 ptsGood

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

 3.95 to >3.45 ptsFair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

 3.45 to >0 ptsPoor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.45 ptsExcellent

Uses correct APA format with no errors.

 4.45 to >3.95 ptsGood

Contains a few (1 or 2) APA format errors.

 3.95 to >3.45 ptsFair

Contains several (3 or 4) APA format errors.

 3.45 to >0 ptsPoor

Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100

 



		


		
		
		
		
	


	
		
			


	


	


	

		

			
			
				
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