Question

Client Profile

Jean Marie Bowberry is a 36 year old married female seeing the doctor to confirm a positive home pregnancy test. She arrives in the clinic with her husband, Tom, an American naval officer. Jean Marie works full time as an accountant in Puerto Rico where her husband is stationed. She had an abortion 10 years ago and another miscarriage two years ago. She complains of tender breasts and intermittent nausea. Her last menstrual period was November 16.

Case Study

In assessing Jean’s nutrition, the nurse finds that she is having 1-2 glasses of wine each night with dinner. Also, she states, “Milk makes me sick, I cannot stand the sight or smell of it.” Tom tells the nurse that in Puerto Rico an Alpha – fetoprotein test was done, they were told that it was abnormal. Jean Marie is scheduled for an amniocentesis. When asked by the nurse if she has questions about the test, Jean Marie says, “I’m afraid the baby will be stuck with the needle and how will I stop the fluid from leaking out?”

As Jean Marie is leaving the office to make her next appointment she says, “You mean I do not need to see anyone for a whole month? What if something goes wrong, how will I know?”

Questions

1. What methods are available to calculate her gestational age of pregnancy?

2. If it was determined she was 8 weeks pregnant, how would you access the fetal heart tones (FHT)?

3. Describe some of the physiological and anatomical changes in her pregnancy?

4. What is Jean Marie’s gravida, parity, G/TPAL, and due date?

5. Should Jean Marie modify her diet to support her pregnancy? If so, how?

6. What are the implications of the alpha- fetoprotein (AFP) test and when is the alpha- fetoprotein (AFP) test normally done?

7. What specific information should the nurse give Jean Marie and Tom about indications of the amniocentesis test and the procedure itself?

8. How would you answer Ms Marie’s concern about the needle stuck etc?

8a. What other fetal assessment tests may be done to assess fetal development? What are their indications and contraindications and or complications?

9. How should the nurse respond to Jean Marie’s question about her next appointment, and what specific things should he or she tell Jean Marie at this first visit?

10. From what you know so far, what information would you provide Marie about her health and pregnancy anticipatory guidance?

Answer 1

1). Based on menstrual history: Gestational age (GA) can be calculated by considering the LMP or the last menstrual period. In general, conception occurs at the 14^th day of menstrual cycle, but the time of ovulation may vary from one individual to the other. The date of menstruation is usually calculated as “-27 to +9 days.”

Date of pregnancy test: Determining the date of first positive pregnancy test can also be used to determine the gestational age. For example, if the first positive test result was obtained after one week of conception, then the gestational age is 5+2 = 7 weeks of amenorrhea.

Clinical examination: It is the most reliable method, and can be used clinically. In this, the uterus size can be assessed by the palpation of the abdominal region or by pelvic examination. Presence of uterine fibroids and the full bladder can be misleading.