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327: Nursing Grand Rounds

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Stephanie Shaw

on 25 June 2014

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Transcript of 327: Nursing Grand Rounds

Nursing Grand Rounds

Case Study
Background Data
Clinic RN: Family Planning
Maya, will counsel Kerry about her pregnancy options





What percentage of rapes result in pregnancy?

A. 0%
B. <1%
C. 5%
D. 10%






Kerry is interested in breastfeeding her baby. Which method of birth control is NOT safe for breastfeeding moms?

A. Intrauterine Device (IUD)
B. Depoprovera
C. Nexplanon (subdermal implant)
D. Ortho Tri-Cyclen

OB RN: Prenatal Care
Katherine, will counsel Kerry on prenatal care





What diet considerations would be appropriate for this patient?
(Name 3)





What would be important to consider when planning appointments during the pregnancy?
(Name 2)




What are some other risks or concerns with this client?
(Name 3)
Nurse Specialist: STDs
Jackie, will educate Kerry about the implications of her herpes infection during pregnancy






How do the majority of transmissions of HSV occur from mother to baby ?

A. In utero
B. Postnatal transmission
C. During breastfeeding
D. During the intrapartum period





What ways decrease the risk of transmission from mother to baby?
a. Cesarean section is the recommended for all births regardless if mother is symptomatic or asymptomatic.
b. Provide suppression therapy with acyclovir (Zovirax) or valacyclovir (Valtrex) throughout the pregnancy.
c. Provide suppression therapy with acyclovir (Zovirax) or valacyclovir (Valtrex) daily at 36 weeks gestation until birth.
d. Recommend the use of herbal supplements, such as, lemon balm to decrease the risk of viral shedding.







Symptoms of HSV in neonate include:
(Select all that apply).
A. Fever
B. Fluid-filled blisters of skin, eye, or mouth
C. Hypothermia
D. Lethargy
E. Decreased desire to feed
Nurse Practioner: Psychiatric Care
Ali, will address her psychiatric needs concerning trauma related to rape and the parenting role




What psychosocial stage and cognitive stage is Kerry in?





What are the clinical manifestations of PTSD?
(Name 2)





Why is a child at a higher risk for abuse and neglect by a teen-mom?
(Name 3)
Case Management APRN
Kelly, will coordinate Kerry's care from her initial visit and throughout her pregnancy, until all her needs have been met




What are Kerry's options for covering her medical costs?











Kerry is unsure if she would like to discuss her situation with her mother. What are her confidentiality rights and, as a health care team, is it our responsibility to inform her parents?

A. Since Kerry has been diagnosed with an STD, her parents will have to be informed since herpes is a reportable communicable disease.

B. In New York State, persons age 16 and under must have a parent or guardian present when discussing family planning.

C. The nurse should instruct Kerry that having her mother present will make her feel more at ease, but that the decision is ultimately up to her.

D. In New York State, care that an adolescent may consent to is considered confidential, as long as there are not suicidal/homicidal ideations or reportable abuse.







To improve cultural competence the nurse researches Hispanic culture. What are some components of this culture related to pregnancy and teen pregnancy?

Answer
Jacqueline Curley, Katherine Griese, Maya Hensley Lapham, Alicia Hopkins, Kelly Mack & Stephanie Shaw

Question 3
300 Points


Question 3
300 Points


Question 2
200 Points


Question 1
100 Points


Question 1
100 Points


Question 2
200 Points


Question 3
300 Points


Question 3
300 Points


Question 2
200 Points


Question 1
100 Points


Question 1
100 Points


Question 2
200 Points


Question 3
300 Points

Case Study Progress





Answer
After careful consideration of her options, Kerry decides to keep the baby and pursue further treatment






Kerry is concerned that having an abortion will affect her fertility in the future. In order to address these fears, her nurse should:

A. Refer her to a physician.

B. Reassure her that having an abortion will not affect her fertility

C. Inform her that studies on the subject have been inconclusive.

D. Inform her that her future fertility will depend on the gestational age of the fetus when the procedure is performed.

Question 2
200 Points


Question 1
100 Points

C. 5%
D. Fertility risk depends on gestational period during procedure
D. Ortho
Tri-Cyclen
Prenatal vitamins
Hydration
Limit caffeine
Increase calories
Balanced diet
Limit fast food, sweets
Serving sizes
Nutritional values
Choose provider/hospital
Importance of attendance
GTT/NST
Housing
Sexual health
Stress
Exercise
Weight gain
D. Intrapartum period
C. Provide suppression therapy with acyclovir (Zovirax) or valacyclovir (Valtrex) daily at 36 weeks gestation until birth
B. Fluid-filled blisters
of skin, eye, or mouth
C. Hypothermia
D. Lethargy
E. Decreased desire to feed
Identity formation
Formal Operations
Re-experiencing the event
Avoidance of enjoyable activities
Avoidance of place/circumstances that event occurred
Increased state of psychomotor arousal
Impulsive/self-centered
Stress related to identity/new roles
Eagerness to please peers
Short-sighted planning
Lack of financial resources
Lack of knowledge r/t healthy pregnancy/child rearing
Poor attitude toward parenting role
Private Insurance
Cash
Medicaid
Child Health Plus
Medicaid Prenatal Care Assistance Program (PCAP)
D. There are no laws in New York State regarding family planning education of a minor. Any care that an adolescent may consent to is deemed confidential, excluding presence of suicidal/homicidal ideations or abuse.
Often marry and start a family early
Higher birth rate and a higher fertility rate
Abortion, adoption, and artificial insemination less acceptable to Hispanics
Women forced into a dependent position: unable to make their own simple decisions
Pregnancy = "hot state"
Deformities related to unsatisfied cravings, burial of placenta/cord, avoidance of funerals
Care Plan
Outcomes:
Kerry will verbalize decreased anxiety about her scheduled prenatal visits and will be able to repeat her schedule back to the nurse by the end of her prenatal visit.
Kerry will show appropriate weight gain per trimester, not exceeding 25-35 pounds for the entire pregnancy.
Kerry will verbalize a decrease in the level of guilt felt related to past rape by the end of her next prenatal visit.
Kerry will report sleeping 7-8 hours most nights per week by the end of her first trimester.

Diagnosis:
Imbalanced Nutrition: Less than body requirements related to knowledge deficit about which types of food to consume as evidenced by Kerry’s statement, “Am I supposed to be eating certain foods?”
Nursing Interventions:
Advise Kerry to consume small, frequent meals and avoid having an empty stomach
Suggest that Kerry eats a simple carbohydrate such as dry crackers before arising in the morning if she feels nauseous, to limit caffeine to less than 200mg per day, and to completely avoid processed foods, nitrates, and alcohol
Diagnosis:
Ineffective coping: secondary to PTSD diagnosis as evidenced by memory loss and lack of sleep.
Nursing Interventions:
Refer Kerry to psychiatric counseling that will assist in confronting her past trauma
Administer any prescribed medications
Diagnosis:
Anxiety: related to deficient knowledge about schedule of prenatal visits throughout pregnancy as evidenced by woman’s questions and concerns
Nursing Interventions:
Provide information regarding schedule of visits, tests, and other assessments and interventions that will be provided throughout pregnancy
Allow Kerry time to describe level of anxiety
Provide information to Kerry regarding prenatal classes and labor area tours
Plan of Care and Interventions:
- Education about maternal and fetal changes
- Sexual counseling
- Psychosocial support

Evaluation:
- Members of the health care team will evaluate if each goal is met and will update the plan of care accordingly.
-Members will evaluate each others work using an interdisciplinary approach
References

Cappiello, J. D., Beal, M. W., & Simmonds, K. E. (2011). Clinical issues in post-abortion care. The Nurse Practitioner, 36(5), 35–40.

Holmes, M. M., Resnick, H. S., Kilpatrick, D. G. & Best, C. L. (1996). Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women. American Journal of Obstetrics and Gynecology, 175(2), 320-325.

John Snow Inc. (2014). Centers for Disease Control and Prevention (CDC): Teen pregnancy prevention. U.S. Health. Retrieved from http://www.jsi.com/JSIInternet/USHealth/project/display.cfm?ctid=na&cid=na&tid=40&id=7641

Littleton, H., & Henderson, C. (2009). If she is not a victim, does that mean she was not traumatized? Evaluation of predictors of PTSD symptomatology among college rape victims. Violence Against Women, 15(2), 148-167. doi:10.1177/1077801208329386

Nackenson, M.J. (n.d.) Legal and ethical issues in adolescent medicine [PowerPoint slides]. Retrieved from http://www.nymc.edu/adolescentmedicine/Slide%20Presentations/Legal%20and%20Ethical%20Issues%20in%20Adol..pps

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, Missouri: Elsevier.

Poma, P.A. (n.d.) Pregnancy in Hispanic women. Journal of the National Medical Association, 79, 934. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625605/pdf/jnma00924-0043.pdf

Richardson, K. & Shannon, M. (2012). STI screening & treatment in pregnancy. The Nurse Practitioner, 37(12), 30-37. doi: 10.1097/01.NPR.0000422203.95229

Wood, S. (2011). Answering questions about herpes in pregnancy. The Journal of Perinatal Education, 20(1), 61-63. doi: 10.1891/1058-1243.20.1.61
Patient:
Kerry
16 year old girl
Herpes simplex virus 2 (HSV-2)
Pregnant
8 weeks gestation
Rape victim
Family structure
School/work
Clinic visit for herpes
Ex-boyfriend sexually assaulted Kerry
Report of rape
Full transcript