Posted: May 1st, 2022

OB Case Scenario Project #1

OB Case Scenario Project #1

Ann works full-time as a crossing guard at an elementary school. She is a married 34 year-old G1P0, 32 weeks pregnant woman and reported to her OB this morning that she has been experiencing some “spotting”. She has just been told by her OB that she as PLACENTA PREVIA and has been sent home on bedrest.

• What is Placenta Previa?

• How may this diagnosis affect the rest of her pregnancy? Her home life/ emotional/ financial/ sexual needs?

• Ann should notify her doctor if she experiences what symptom/sign?

• How will this affect the delivery of her baby?

• What concerns might you have about her delivery?

• What will her postpartum recovery be like afterwards?

• As her postpartum nurse, describe your plan of care for her including any medications/ labs/ nursing diagnoses that you feel may be relevant.

OB Case Scenario Project #2 Maria is 37 weeks pregnant. She is worried and visits her doctor with a concern. Maria states “her sister had a baby four years ago and something happened. She had an abruption. The doctor says that it was called a PLACENTA ABRUPTION. Maria is concerned that she can have this too!

• What is Placenta Abruption?

• How may this diagnosis affect the rest of her pregnancy? Her home life/ emotional/ financial/ sexual needs?

• What signs or symptoms would a patient experience if they were experiencing a placenta abruption?

• How will this affect the delivery of her baby?

• What concerns might you have about her delivery?

• What will her postpartum recovery be like afterwards?

• As her postpartum nurse, describe your plan of care for her including any medications/ labs/ nursing diagnoses that you feel may be relevant.

OB Case Scenario Project #3

Sasha is a 25 year-old, G3P2, 29 week pregnant woman who stays at home three days a week with her younger children and works two days a week as a trial lawyer. Her income is needed to maintain her home and family. Recently she has been experiencing lots of cramping, backache, and pelvic pressure. Her doctor tells her she may be in PRETERM LABOR and sends her to the hospital to be evaluated.

• What is Preterm Labor?

It has been decided that Sasha will spend the remainder of her pregnancy in the antepartum unit at the local hospital. • How may this diagnosis affect the rest of her pregnancy? Her home life/ emotional/ financial/ sexual needs? • What medications may be used to treat her preterm labor? • What medication may they give her to help with the development of her unborn baby’s lungs? • As her LPN, what testing or blood labs can you expect the doctor to order?

At 32 weeks gestation, Sasha’s water breaks, and goes into labor. She delivers a 3lb. 5 oz. baby girl by vaginal delivery. • What are your concerns as her nurse if the baby is delivered at 32 weeks gestation? •Will she be able to see, hold and breast feed with her baby right after delivery? • As her postpartum nurse, describe your plan of care for her including any medications/ labs/ nursing diagnoses that you feel may be relevant.

OB Case Scenario Project #4 Monica is a 26 year old, G1P0, 38 week pregnant nursing student at Keiser Career College! She has been studying very hard lately for her ATI exam. For the past two days she has been having really bad headaches, blurry vision, and feels “fat”. She weighs herself and sees that she is 12lbs heavier than two weeks ago and sees her face and hands very puffy! Her OB just told her that she has PRE-ECLAMPSIA and has been sent to the hospital for bed rest.

• What is Pre-Eclampsia? • How may this diagnosis affect the rest of her pregnancy? Her home life/ emotional/ financial/ sexual needs? • What medications may be ordered to treat her pre-eclampsia? What antidote should you have at her bedside as well? • Describe the condition of her hospital room.

As the LPN, you are helping the RN watch Monica’s condition closely. •What physical findings are you assessing her for probably hourly? • Which changes in her assessment would you report to her doctor immediately???

• How will having pre-eclampsia affect the delivery of her baby? • What concerns might you have about her delivery? • What will her postpartum recovery be like afterwards? • As her postpartum nurse, describe your plan of care for her including any medications/ labs/ nursing diagnoses that you feel may be relevant.

OB Case Scenario Project #5 Tanya is a 31 year old, G2P1, 41 week pregnant woman. Her doctor is concerned that Tanya has gone past her due date and schedules her for an INDUCTION in the morning at the hospital.

• What is an Induction?

• What medications may her doctor use to induce her labor? • What types of testing can you expect the doctor to order?

You are her nurse and Tanya tells you that she did not attend any prenatal classes. Prior to starting her induction she asks you to tell her a little about labor.

• Describe for her the four stages of labor. • Explain to her the three different phases of labor. • Discuss her possible options for management of pain during labor. (Include one non-pharmacological comfort measure, one IV pain med, and one anesthesia).

OB Case Scenario Project #6 Roberta is a 26 year old, 39 week pregnant woman who was just told by her doctor, at her office visit, that she needs a CESAREAN SECTION.

• What is a cesarean section?

• Why might a NON-LABORING pregnant woman need a cesarean section? Name and explain 3 reasons. • Why might a LABORING pregnant woman need a cesarean section? Name and explain 2 reasons.

You are her nurse in the pre-op area and are getting her ready for the operating room. She asks you to: describe briefly what will happen in the OR.

She asks you about her recovery after the surgery. • Describe for her how she will look and feel after surgery when she gets to the Post Partum Unit. • Explain some of the medications that may be ordered for her to take. Name and explain 3.

You are reviewing discharge teaching of a cesarean patient with her. You tell her that compliance is important. Teach her 2 things that you hope she complies with.

________________________
Study Notes:OB Case Scenario Project #1

Title: Understanding Placenta Previa and Its Impact on Pregnancy and Postpartum Care

Introduction:
Placenta previa is a condition in which the placenta partially or completely covers the cervix during pregnancy, causing potential complications. In this article, we will explore the implications of placenta previa on Ann, a 34-year-old pregnant woman, and discuss its effects on her pregnancy, home life, emotional well-being, financial situation, sexual needs, delivery, postpartum recovery, and the nursing care required during this critical period.

What is Placenta Previa?
Placenta previa is a condition where the placenta implants low in the uterus, close to or covering the cervical opening. This positioning can lead to bleeding, especially as the cervix begins to efface and dilate during labor. The severity of placenta previa varies, ranging from marginal, where the placenta is near the cervix, to complete, where it fully obstructs the cervical opening.

Impact on Pregnancy and Quality of Life:
The diagnosis of placenta previa may significantly affect Ann’s pregnancy experience. Bedrest is commonly recommended to minimize the risk of bleeding and complications associated with this condition. This restriction can have implications for her home life, financial situation, and emotional well-being, as it may limit her ability to work and engage in daily activities.

Moreover, placenta previa can impose restrictions on sexual activities due to the risk of bleeding. It is essential for Ann and her partner to understand and cope with these changes to maintain a healthy emotional and sexual relationship during this challenging time.

Symptoms Requiring Medical Attention:
Ann should immediately notify her doctor if she experiences vaginal bleeding, abdominal pain, or contractions. These symptoms may indicate potential complications and require prompt Assessment.

Effect on Delivery:
Placenta previa increases the risk of severe bleeding during labor and delivery. Depending on the severity and location of the placenta previa, a cesarean section may be the safest option to prevent life-threatening hemorrhage.

Concerns About Delivery:
During delivery, the primary concern is managing bleeding and ensuring the health and safety of both Ann and her baby. Close monitoring and prompt medical intervention are crucial to handle any potential emergencies effectively.

Postpartum Recovery:
Following delivery, Ann’s postpartum recovery may be influenced by the mode of delivery and any potential complications during childbirth. Recovery from a cesarean section may involve a longer hospital stay and require additional postoperative care. Emotional support and education about caring for her newborn will be vital during this period.

Plan of Care for Postpartum Nurse:
As Ann’s postpartum nurse, the plan of care would include close monitoring of vital signs, assessing for any signs of bleeding or infection, and providing pain management as needed. Nursing diagnoses may include risk for impaired parenting related to limited mobility or knowledge deficit. Medications, such as analgesics and antibiotics, may be prescribed based on the physician’s orders.

Conclusion:
Placenta previa is a challenging condition that requires careful management throughout pregnancy and delivery. Understanding its implications on pregnancy, delivery, and postpartum recovery is essential for healthcare providers to provide appropriate care and support for patients like Ann.

References:

Kramer MS, Berg C, Abenhaim H, et al. Incidence, Risk Factors, and Temporal Trends in Severe Postpartum Hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-7. doi:10.1016/j.ajog.2013.08.020

Ananth CV, Friedman AM, Gyamfi-Bannerman C. Epidemiology of Preterm Birth and Stillbirth: The Role of Time-Varying Risk Factors. Semin Perinatol. 2017;41(7):610-617. doi:10.1053/j.semperi.2017.08.010

Melamed N, Hiersch L, Domniz N, et al. Predictive factors for hypertensive disorders and related adverse maternal and perinatal outcomes following late preterm premature rupture of membranes. Am J Obstet Gynecol. 2016;215(4):505.e1-505.e10. doi:10.1016/j.ajog.2016.05.043

Balci O, Acar A, Citil A, et al. Expectant management of partial and complete placenta previa in the third trimester. Arch Gynecol Obstet. 2016;294(2):249-253. doi:10.1007/s00404-015-4057-9

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