XAVIER UNIVERSITY ATENEO DE

CAGAYAN - COLLEGE OF NURSING

A.Y.

2017-2018

Case Study

Submitted by:

Ma. Elyza Allene N.

Paderanga
Level IV Student Nurse
BSN- IV NA

Submitted to:
Mrs. Mary Grace Paayas, RN, MAN

Mrs. Leny Baguio, RN,MN

Mrs. Rhenzi Pepito, RN, MN

Mrs. Mildred Pinque, RN, MN

Mr. Philip Eli Nalzaro, RN, MN

August 16, 2017

 Case Study

A 34-year-old Hispanic-American woman who is in her second pregnancy and has had
one live birth and no abortions is seen for prenatal care at 24 weeks gestation. Her
weight is 220 lb, and her blood pressure is 130/80 mmHg. Uterine size is appropriate for
gestational age. The patient's past obstetric history includes the spontaneous vaginal
delivery of a 9 lb, 8 oz. male infant at 40 weeks gestation, 8 years ago in Mexico. The
patient reports that the child is doing well. Her family history reveals that her mother has
type 2 diabetes mellitus. A urine dipstick shows 3+ glycosuria and negative ketones.

Patient has a few factors that make her susceptible to the condition of Diabetes Mellitus.
The factors are her age, her ethnicity, gender, her obese weight and familynhistory from
her mother's DM type 2. With these factors, she is already prone to acquiring the
condition. It is not known she has acquired DM before or after her pregnancy. But there
are tests that can determine the confirmation of her DM. The test during diabetigenic
phase of pregnancy which is a 50 gram oral glucose loax administered between the
24th to 28th week of gestation. Gestational DM can be confirmed with this test and also
a capillary glucose reading and a fasting venous plasma glucose. A glycohemoglobin
can be done to determine if a pre-existing DM condition is and was present even before
pregnancy. Early screening is relevant to the pregnancy outcome, health and wellbeing
of both mother and infant. Patient is educated about treatment of this condition with diet
and insulin can increase intrauterine death and so, are fetal tests are also done.

QUESTIONS

1. Which of the following urinary symptoms does the pregnant woman most frequently
experience during the first trimester?

A. Dysuria

B. Frequency

C. Incontinence
D. Burning

ANSWER: B. Pressure and irritation of the bladder by the growing uterus during the first
trimester is responsible for causing urinary frequency. Dysuria, incontinence, and
burning are symptoms associated with urinary tract infections.

2. The nurse hears a mother telling a friend on the telephone about umbilical cord care.
Which of the following statements by the mother indicates effective teaching?

A. Daily soap and water cleansing is best

B. Alcohol helps it dry and kills germs

C. An antibiotic ointment applied daily prevents infection

D. He can have a tub bath each day

ANSWER: B. Application of 70% isopropyl alcohol to the cord minimizes

microorganisms (germicidal) and promotes drying. The cord should be kept dry until it
falls off and the stump has healed. Antibiotic ointment should only be used to treat an
infection, not as a prophylaxis. Infants should not be submerged in a tub of water until
the cord falls off and the stump has completely healed.

3. A postpartum primipara asks the nurse, When can we have sexual intercourse
again? Which of the following would be the nurses best response?

A. Anytime you both want to.

B. As soon as choose a contraceptive method

C. When the discharge has stopped and the incision is healed

D. After your 6 weeks examination

ANSWER: C. Cessation of the lochial discharge signifies healing of the endometrium.
Risk of hemorrhage and infection are minimal 3 weeks after a normal vaginal delivery.
Telling the client anytime is inappropriate because this response does not provide the
client with the specific information she is requesting. Choice of a contraceptive method
is important, but not the specific criteria for safe resumption of sexual activity. Culturally,
the 6-weeks examination has been used as the time frame for resuming sexual activity,
but it may be resumed earlier.

4. When performing a pelvic examination, the nurse observes a red swollen area on the
right side of the vaginal orifice. The nurse would document this as enlargement of which
of the following?

A. Clitoris

B. Parotid gland

C. Skenes gland

D. Bartholins gland

ANSWER: D. Bartholins glands are the glands on either side of the vaginal orifice. The
clitoris is female erectile tissue found in the perineal area above the urethra. The parotid
glands are open into the mouth. Skenes glands open into the posterior wall of the
female urinary meatus.

5. A patient is in labor and has just been told she has a breech presentation. The nurse
should be particularly alert for which of the following?

A. Quickening

B. Ophthalmia neonatorum

C. Pica
D. Prolapsed umbilical cord

ANSWER: D. In a breech position, because of the space between the presenting part
and the cervix, prolapse of the umbilical cord is common. Quickening is the womans
first perception of fetal movement. Ophthalmia neonatorum usually results from
maternal gonorrhea and is conjunctivitis. Pica refers to the oral intake of nonfood
substances.

SOURCES:

http://journal.diabetes.org/clinicaldiabetes/V17N31999/Pg140.htm

http://thenursingcorner.blogspot.com/2010/09/maternal-and-child-health-nursing.html