Care Plans for Pregnancy
Posted: Jan 11, 2019
The Negele’s rule was used to estimate the date of delivery using the information the patient gave concerning her last date menstrual period (LMP). It is essential to ensure that the patient is certain of her date and also to consider if the menstrual period was a normal flow as well as its duration. It also entails asking the patient if her cycles were consistent in each 28 to 30 days (Schuiling and Likis, 2013). Negel’s rule requires the calculation of the due date by adding seven days to the LMP’s first day and subtracting three months. For this scenario finding the estimated date of delivery is through the following calculations.
The patient is visiting the clinic after taking a home pregnancy test when she found out she had a missed cycle. The test result was positive. Urine pregnancy testing that is positive can be established around the time of the first missed menses (Schuiling and Likis, 2013). The patient also reports of feeling nausea and breast tenderness which are both the clinical symptoms of pregnancy. It is possible to detect most pregnancies in a reliable way by assessing the clinical symptoms, signs as well as physical examination (Schuiling and Likis, 2013, p 144).
Clinical guidelines for screening and procedures
For this scenario, the patient is in her first trimester, and it is her first prenatal visits. Due to it is her initial visit, there is a need for a thorough health history that comprises of prior obstetric, menstrual, environmental, social, infectious diseases and whether she has a history of substance use histories. The assessment will also cover the history of her current pregnancy (U.S. Department of Health and Human Services, 2012). The physical exam will also comprise of a routine gynecological exam with the assessment of the uterus and cervix and a Pap smear test. There is also need to include various laboratory tests for this is the initial prenatal visit. The lab test will cover blood type plus Rh factor, CBC, screening for Rh antibody, hepatitis B, rubella titer, urine culture, varicella antibody screen, Chlamydia, syphilis, and gonorrhea (Tharpe, Farley & Jordan, 2013). In the case of doubt with LMP, a transvaginal ultrasound can be used to confirm the due date. Missed screenings can result in the spreading of STIs to the unborn baby.
The patient will be advised to come back for additional tests, later in her pregnancy. The tests will be for cystic fibrosis, Down syndrome, and spina bifida. She will also be recommended to do tests on glucose tolerance for gestational diabetes as well as group B strep (National Institutes of Health, 2012).). Some of these screenings are optional and time dependent, and it’s always a good aspect to give this information to patients at their first prenatal visit (Schuiling and Likis, 2013).
Educating the patient is an essential aspect of patient care in any settings and a vital aspect of all prenatal care. The primary component of prenatal education is lifestyle modification (Schuiling & Likis, 2013). Such changes aim at doing away with risks linked to smoking and alcohol use during pregnancy (Schuiling and Likis, 2013). She will also be educated on over the counter prescriptions that are safe and the unsafe ones during pregnancy. Also, matters of the use of saunas and hot tubs, sexuality, exercises and the use of seat belts will also be discussed. Patient education will also include matters of dietary habits and nutrition as well as the amount of weight she has to gain depending on her BMI (Schuiling and Likis, 2013)
Women’s Gynecologic health (2nd Ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N, Farley, C., & Jordan, R. (2013). Clinical Practice Guidelines for Midwifery & Women’s health (4th Ed.). Burlington, MA: Jones & Bartlett Publishers.
National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH).
U.S. Department of Health and Human Services. (2012a). Womenshealth.gov.
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