Prenatal Case Study # 1 - Hypertension

Objective:

• Discuss and review case study with supervisor to involve student in the decision making realities of the home care setting.
• Case study is to be used as a basis for conference with a supervisor and/or peer group.

Patient Presentation

Peggy Pregnant is a 38 year old female who will be having a prenatal home care visit at the referral of her CNM. She is 25 weeks pregnant. This is her first pregnancy. She has some complaints of mild intermittent headaches, fatigue and some lower extremity swelling and has had one episode of elevated blood pressure of 140/90.

History

Mrs. Pregnant has been married for eight years and this is her first pregnancy. She attended two years of college and works full time as a hair dresser so she is on her feet most of the day. She has been active in her community and church. She also volunteers. She runs 3 miles per day.

Mrs. Pregnant is of African American descent. Her parents are alive and in fair health. Her mother has hypertension and hyperlipidemia both of which she takes medication for. Her father also has hx of elevated blood pressure; however, his is well controlled by lifestyle changes (dietary changes, exercise, and weight loss). Her maternal grandfather died from complications of heart disease at an early age.

Mrs. Pregnant reports having the "normal" childhood illness of chickenpox. She does have a documented pre-hypertension prior to her pregnancy. She denies any other complications or prolonged illnesses or injuries.

Review

• What are Mrs. Pregnant’s risk factors?
• What are her strengths?
• What would you include in your subjective assessment?
• What would you include in your review of systems?
• What will you include in your physical assessment?
• What will you include in your psycho-social assessment?
• What and when would you check in with her provider?
• What anticipatory guidance would you include in your visit?
• What plan of care would you propose to Mrs. Pregnant and her provider for further home care involvement?

Prenatal Case Study # 2 – Tobacco Abuse & Psycho-Social Risks

Objective:

• Discuss and review case study with supervisor to involve student in the decision making realities of the home care setting.
• Case study is to be used as a basis for conference with a supervisor and/or peer group.

Patient Presentation

Cindy Sue is a 19 year old female client who will be having prenatal home care at the request of her OB/GYN. Ms. Sue is 15 weeks pregnant. This is her second pregnancy. To date she has had a slow weight gain and mild exacerbation of her asthma.

History

Ms. Sue is a single mother. She has a two year old son at home. She has a high school diploma. She is not working. The father of her son is not involved nor is the father of the baby. She does not have a great support network in place. Ms. Sue is a 1 ppd smoker and has a poor diet. She drinks several cups of coffee and cola per day. She sleeps an average of 4 – 5 hours per night. Her stress level is high as result of financial struggles and single parenting.

Ms. Sue had a turbulent childhood which left her with a history of post traumatic stress disorder. She takes anti-depressant medication daily which helps her control her depression and anxiety. She did have significant post partum depression after the birth of her first child. She is not in counseling. She also has a hx of asthma. She denies any other complications or prolonged illnesses or injuries. She denies any alcohol or illicit drug use.

Review

• What are Ms. Sue’s risk factors (physical & psychological)?
• What are her strengths?
• What would you include in your subjective assessment?
• What would you include in your review of systems?
• What will you include in your physical assessment?
• What will you include in your psycho-social assessment?
• Why and when would you check in with her provider?
• What anticipatory guidance would you include in your visit?
• What community resources would you refer Ms. Sue to?
• How would you assess Ms. Sue’s readiness for change around her smoking cessation and how would you proceed with information you gained from that assessment?
• What plan of care would you propose to Ms. Sue and her provider for further home care involvement?