Pregnancy Case Study

Client Profile

Jean Marie Bowberry is a 36-year-old married female seeing the doctor to confirm a positive
home pregnancy test. She arrives in the clinic with her husband, Tom, a correctional officer.
Jean Marie works full time as an accountant in Toronto. She had an abortion 10 years ago and
another miscarriage two years ago. She complains of tender breasts and intermittent nausea.
Her last menstrual period was November 16th 2019.

Case Study

In assessing Jean’s nutrition, the nurse finds that she is having 1-2 glasses of wine each night
with dinner. Also, she states, “Milk makes me sick, I cannot stand the sight or smell of it.” Tom
tells the nurse that an Alpha – fetoprotein test was done; they were told that it was abnormal.
Jean Marie is scheduled for an amniocentesis. When asked by the nurse if she has questions
about the test, Jean Marie says, “I’m afraid the baby will be stuck with the needle and how will I
stop the fluid from leaking out?”

As Jean Marie is leaving the office to make her next appointment she says, “You mean I do not
need to see anyone for a whole month? What if something goes wrong, how will I know?”

Questions

1. What methods are available to confirm pregnancy and calculate her gestational age of
pregnancy?

Ultrasound, Last menstrual cycle, Negele’s rule

2. If it was determined she was 8 weeks pregnant, how would you access the fetal heart
tones (FHT)?

At 8 -1 2 weeks, an ultrasound can be used to assess the fetal heart tones. Doppler

3. Describe some of the physiological and anatomical changes in her pregnancy?

Nausea and sometimes vomiting occur during the first trimester. Distaste and cravings
of certain food. Breast tenderness and increase pigmentation of areola and nipples.
Estrogen and progesterone increase. Oxytocin at birth. Waddle gait. Lenea alba.

4. What is Jean Marie’s gravida, parity, G/TPAL, and due date?

Gravida 3, Parity 0. G-3/T-0,P-0,A-2, L-0. Her due date should be August 23.
 4. Should Jean Marie modify her diet to support her pregnancy? If so, how?
She must stop drinking as there is an increased risk of FAS and low birth weight. She
should be on prenatal vitamin that have folic acid. She can substitute milk to cheese for
calcium

5. What are the implications of the alpha- fetoprotein (AFP) test and when is the alpha-
fetoprotein (AFP) test normally done?
The test is done at 15 – 20 weeks of pregnancy. It will identify high levels, which are
associated with open defects, such as spina bifida (open spine), anencephaly
(incomplete development of the skull and brain), or gastroschisis (open abdominal
cavity).

7. What specific information should the nurse give Jean Marie and Tom about indications of the
amniocentesis test and the procedure itself?

It is Performed at 16-20 weeks of gestation when high-risk problem is suspected. This

8. How would you answer Ms Marie’s concern about the needle stuck etc.?

I would tell her needle puncture of the fetus rarely occurs during amniocentesis because
of the use of ultrasound technology, which allow visualization of the fetus. We also
observe for any complications after the procedure

8a. What other fetal assessment tests may be done to assess fetal development? What are
their indications and contraindications and or complications? here are some tests to assess fetal
development include:

Non-stress test: used to evaluate fetal status. It is based on the knowledge that the fetus
has adequate oxygenation and an intact central nervous system. There are no known
side effects.
Contraction stress test: evaluates the respiratory function of the placenta. Identify risk
for intrauterine asphyxia trough observation of the fetal heart rate FHR. Negative CST
shows 3 contractions of good quality lasting 40 or more seconds in 10 minutes without
evidence of late decelerations. Positive CST shows repetitive persistence late
decelerations with more than 50 % of the contractions.

9. How should the nurse respond to Jean Marie’s question about her next appointment, and
what specific things should he or she tell Jean Marie at this first visit?
The recommended frequency of antepartum visits is as follows:

For the first 28 weeks of pregnancy, every 4 weeks. Every two weeks till the baby is 36
weeks old, and Every week after week 36, till labor. The nurse must explain to the patient
what is normal and what to look out for during the first trimester

10. As the nurse based on what you know so far, what health teaching would you provide to
Marie in relation to her pregnancy and presentation?

- She can wear a supportive and fitting bra to help with Breast tenderness.
- To help with nausea, she can try ginger or carbonated beverages, and avoid greasy food
- Give her pamphlets and resources as to how to deal with stress

11. What are terminologies have you learned so far?

Gestational Age
Amniocentesis
Non Stress Test
CST
Fetal Heart Rate
Para
Gravida
Abortion
Postpartum
Alpha feto-protein
Fetal Heart Tones