What steps could Sarah take to minimize further risks to her baby during pregnancy?
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Step 1: Schedule Regular Prenatal Checkups Sarah should schedule regular appointments with her healthcare provider to monitor her pregnancy and address any potential issues early. Show more…
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DFC Post Work (SOAP Notes) Background Today you are meeting with Laura, a 34-year-old woman who is 30 weeks pregnant. Laura has had one previous pregnancy that resulted in the birth of a 4400 g healthy baby, Sarah, who is now 16 months old. Laura is married, and her husband, David, is with her at this visit. David works full-time as a Physician Assistant, but the practice that he works for has recently been purchased by a health plan and he is unsure about his job's future right now. Laura works half-time as a legal secretary. Laura and David carefully planned for their first pregnancy. They were married several years ago but waited to have their first child until they were financially secure enough that Laura could work part-time after the baby came. They both made a point of making healthy food choices and avoiding alcohol when they were trying to conceive their first child. They attended both a preconception health education class and a prepared childbirth class. Sarah proved to be a challenging baby. She is only now beginning to sleep through the night. She had "colic" symptoms until she was almost 6 months old. Laura and David felt strongly about breastfeeding and had been to classes and read books about breastfeeding. However, they encountered some difficulties with breastfeeding for the first few weeks. These included sore nipples, a breast infection, and a perceived lack of an adequate milk supply. When Laura went back to work 3 months postpartum, Sarah eagerly took bottles of formula while her mother was at work. Despite Laura's plan to maintain exclusive breastfeeding and pumping of breastmilk for several months, Sarah was soon just nursing a couple of times a day and stopped nursing altogether 2 to 3 weeks after Laura discovered that she was pregnant again. Laura and David had wanted another child at some point, but this current pregnancy was not intended. Although they have accepted the pregnancy, they state that they have concerns about the effect that a new baby will have on Sarah, their marriage, and their finances. Laura and David have good health insurance coverage, but Laura has only been seen 4 times for prenatal care for this pregnancy. Anthropometric Data Laura's prepregnancy weight with this pregnancy was 175 lbs. She is 61" tall. She gained 55 pounds in her first pregnancy and lost 20 of those pounds before she became pregnant again. Today her weight is 200 lbs. Health History Laura's health history is unremarkable. Her blood pressure today is within normal limits. She denies use of drugs or tobacco. Laura states that she does not like to exercise. She joined a health club a few years ago but stopped going after about 6 weeks because she felt out of place and she thought that it was boring. She started a walking program after her first pregnancy with another new mother from her mom's group, but her friend moved away and Laura doesn't like to walk alone. At the beginning of both of her pregnancies, Laura experienced considerable nausea and occasional vomiting as well as overwhelming fatigue. Today Laura complains of the onset of several pregnancy discomforts that also bothered her toward the end of her first pregnancy. These include heartburn, intermittent diarrhea and constipation, fatigue, and edema in her ankles. Laboratory Values Last week Laura had a 50-gram oral glucose screen. Results at one hour were 120 mg/100 ml. Laura's hematocrit today is 31%. Supplements Laura is intermittently taking a standard prenatal vitamin and mineral supplement that contains 30 mg per day of elemental iron. She feels that this supplement has contributed to some of her pregnancy-related discomforts. David has recently been to a continuing education conference on nutrition and reproductive health. There were several vendors of nutritional supplements who displayed products at the conference. He is asking for your advice today about fish oil, zinc, and calcium supplements in pregnancy. Assessment and Plan for Patient a. Synthesis of subjective and objective? b. Not a medical diagnosis, but discusses problems or issues to be addressed? c. Risks – injury, fall, infection? d. Nurse concerns – anxious, depressed, s/s of infection? e. Interventions f. Education g. Consults needed
Adi S.
CASE STUDY 2: Safe Food Choices during Pregnancy: Stephanie F. is a 30-year-old professional woman in her first trimester of pregnancy. She and her husband entertain guests frequently and enjoy specialty cheeses on these occasions. They buy fresh produce, eggs, milk, and cheese from a local farmer’s market each week and limit their intake of packaged foods. She has no food aversions and eats a variety of foods. Stephanie wants to make sure her diet is nutritious and safe for pregnancy. She decides to evaluate her typical daily intake: Breakfast: Coffee with cream and sugar (2-3 cups) Orange juice (1 cup) Bagel with lox and cream cheese Lunch: Fresh vegetable salad with canned tuna or deli turkey Cheese with fruit and crackers Iced tea with sugar and lemon Dinner: Beef, pork, poultry, or fish Pasta or rice Fresh cooked vegetables Snacks: Cookies and milk Fresh fruit During her pregnancy, what special considerations for food safety should Stephanie keep in mind when buying fresh produce, juice, and dairy foods at her local farmer’s market? Explain. What changes could Stephanie make to her usual breakfast to meet the current dietary recommendations for pregnancy presented in this chapter? Explain your answer. Due to their high content of mercury, what types of fish should Stephanie completely avoid during her pregnancy? What precautions regarding meat, poultry, seafood, and eggs should Stephanie be aware of during her pregnancy? Why is it important for her to follow this advice?
Shaiju T.
CASE STUDY 2: Safe Food Choices during Pregnancy: Stephanie F. is a 30-year-old professional woman in her first trimester of pregnancy. She and her husband entertain guests frequently and enjoy specialty cheeses on these occasions. They buy fresh produce, eggs, milk, and cheese from a local farmer's market each week and limit their intake of packaged foods. She has no food aversions and eats a variety of foods. Stephanie wants to make sure her diet is nutritious and safe for pregnancy. She decides to evaluate her typical daily intake: Breakfast: Coffee with cream and sugar (2-3 cups) Orange juice (1 cup) Bagel with lox and cream cheese Lunch: Fresh vegetable salad with canned tuna or deli turkey Cheese with fruit and crackers Iced tea with sugar and lemon Dinner: Beef, pork, poultry, or fish Pasta or rice Fresh cooked vegetables Snacks: Cookies and milk Fresh fruit During her pregnancy, what special considerations for food safety should Stephanie keep in mind when buying fresh produce, juice, and dairy foods at her local farmer's market? Explain. What changes could Stephanie make to her usual breakfast to meet the current dietary recommendations for pregnancy presented in this chapter? Explain your answer. Due to their high content of mercury, what types of fish should Stephanie completely avoid during her pregnancy? What precautions regarding meat, poultry, seafood, and eggs should Stephanie be aware of during her pregnancy? Why is it important for her to follow this advice?
Suman K.
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