Natalie is a 27-year-old G4P0120

Posted: July 7th, 2022

Select a case study of interest to you from the listed scenarios.
Download and complete the Pregnancy Case Review Chart.
• Make sure to address all sections. Do NOT leave any section blank.
• Include relevant subjective and physical objective findings.
• Identify appropriate diagnostic and laboratory testing needed.
• List at least three differential diagnoses with rationales for choosing.
• Identify usual medications, treatments, or patient education needed.
• Determine referrals for collaborative care.
• Provide evidence-based references in APA formatting. Consult with the Writing Center as needed.
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• Be well ordered, logical, and unified, as well as original and insightful
• Displays superior content, organization, style, and mechanics.
• Use Evidence-Based Practice guidelines.
• Utilize APA formatting.
• Case #1: Jane
• Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.
• Case #2: Natalie
• Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32-week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and ultimately died of sepsis. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32-week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam, you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.
• Case #3: Katie
• Katie is a 17-year-old G1P0. She presents to your office with four missed periods in a row. Katie is a high school student; she is in the 10th grade. She lives with her mother and four siblings. You ask Katie about the father of the baby and she tells you he states, “that baby is not mine.” They are not speaking to each other right now. Katie tells you she has been “vomiting a lot and her stomach hurts when she pees.” A urine pregnancy test comes back positive. Katie is so confused because she has been using douching after intercourse as her method of birth control. Katie’s past medical history is positive for chlamydia twice in the last year. She was treated at the Health Department but never went back for a follow up. Katie has had no surgeries and is on no medication. When asked, Katie states her last known weight was about 120 lbs. Katie’s V/S are BP 110/70, temp 102.5, weight 107. You note enlarged cervical lymph nodes, FHTs are 160, and fundal height is 18. Katie’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.
• Case #4: Sara
• Sara is a 32-year-old G1P1001. She presents to your office for a 6-week postpartum check following a normal vaginal delivery of a healthy baby girl. Sara had an 18-hour labor with Pitocin augmentation and delivered a 7 pound 2 oz. girl with a second-degree laceration repaired with sutures. Sara spent 2 days in the hospital and was discharged home with her infant and husband. Over the last few weeks, Sara has called the office multiple times with questions about breastfeeding and her sutures healing. Upon walking into the exam room to see Sara, you see her baby in the stroller crying and Sara sitting on the exam table crying into her hands.

Description of the case chosen:

Subjective data, identify both given and needed data Objective findings, identify both given and needed data Diagnostic or laboratory testing needed with rationales List of three differential diagnoses with rationales Medications and or treatments needed with rationales Patient education needed
Referrals for collaborative care needed with rationales
__________________________

Case #2: Natalie

Subjective data:

Age: 27
Gravidity: 4
Parity: 0, 1, 2, 0
Gestational age: 20 weeks
Lack of prenatal care due to financial constraints and inability to take time off work
History of multiple yeast infections during pregnancy
Negative surgical history
Smoker
Objective findings:

Fundal height: 26 weeks
Urine dip: 1+ leukocytes, 1+ protein, trace blood, and 3+ glucose
Fetal heart tones: to be assessed
Previous pregnancy losses: 8 and 12 weeks, and 32 weeks with premature rupture of membranes
32-week infant: 7 pounds, lived for 24 hours, experienced hypoglycemia, respiratory distress, and died of sepsis
No known medical diagnoses, not taking medications
Diagnostic or laboratory testing needed:

Complete blood count (CBC) to evaluate for anemia and infection
Blood type and Rh status to assess for potential need for Rhogam injection
RPR/VDRL to evaluate for syphilis
HIV testing
Urine culture and sensitivity to evaluate for urinary tract infection (UTI)
Cervical cultures to evaluate for bacterial vaginosis, group B streptococcus, and sexually transmitted infections (STIs)
Ultrasound to assess fetal growth and anatomy and to confirm gestational age
List of three differential diagnoses with rationales:

Gestational diabetes: The presence of glucose in the urine dip may indicate the possibility of gestational diabetes, which is a common complication of pregnancy. Additionally, Natalie has a history of a 7-pound infant with hypoglycemia, which could be related to gestational diabetes.
Urinary tract infection: The presence of leukocytes and glucose in the urine dip could be indicative of a UTI, which is a common occurrence in pregnant women due to the hormonal changes and increased pressure on the urinary tract.
Cervical incompetence: Natalie has a history of pregnancy losses, which could be due to cervical incompetence, where the cervix begins to dilate too early in the pregnancy. This could result in premature delivery and loss of the pregnancy.
Medications and treatments needed with rationales:

Antifungal medication: To treat Natalie’s multiple yeast infections during pregnancy, antifungal medication such as miconazole or clotrimazole cream can be prescribed to provide relief and prevent complications.
Prenatal vitamins: To ensure adequate nutrition for the growing fetus, Natalie should be advised to take prenatal vitamins with folic acid, iron, and calcium.
Smoking cessation: Natalie should be counseled about the risks of smoking during pregnancy and advised to quit smoking. Nicotine replacement therapy can also be considered.
Patient education needed:

Importance of regular prenatal care: Natalie should be educated about the importance of regular prenatal care for the health of both herself and her baby. She should be advised to schedule regular check-ups with her healthcare provider and seek medical attention for any concerning symptoms.
Healthy diet and lifestyle: Natalie should be educated about the importance of a healthy diet and lifestyle during pregnancy. She should be advised to consume a well-balanced diet and engage in moderate exercise.
Management of yeast infections: Natalie should be educated about the prevention and management of yeast infections during pregnancy. She should be advised to wear breathable clothing, avoid douching, and practice good hygiene.
Referrals for collaborative care needed:

Social worker: Natalie may benefit from referral to a social worker to assist with financial and social support resources, such as Medicaid and WIC, and and to provide counseling and support for any emotional or mental health concerns she may have. A social worker can also help coordinate care with other healthcare providers and community resources to ensure that Natalie is receiving comprehensive care.

Psychiatrist: Given Natalie’s history of depression and anxiety, it may be helpful to refer her to a psychiatrist for further evaluation and treatment. A psychiatrist can assess whether medication may be appropriate and provide ongoing management of any psychiatric conditions.

Primary Care Physician: Natalie should be connected with a primary care physician who can provide routine medical care and help manage any chronic health conditions she may have. The primary care physician can also work with Natalie’s other healthcare providers to coordinate her care and ensure that all of her medical needs are being met.

Nutritionist/Dietitian: Referring Natalie to a nutritionist or dietitian can help ensure that she and her child are receiving adequate nutrition. A nutritionist or dietitian can provide education and support to help Natalie make healthy food choices and manage any medical conditions that may require dietary changes.

Childcare Services: Natalie may benefit from referral to local childcare services to ensure that she has adequate support in caring for her child while she attends appointments and receives treatment. This can also help reduce stress and support Natalie in maintaining her overall well-being.

Community Resources: It may be helpful to connect Natalie with community resources such as support groups, parenting classes, and employment services to help support her in achieving her goals and maintaining stability in her life.

A collaborative care approach can be helpful in ensuring that Natalie is receiving comprehensive care that addresses all of her needs. By working together, healthcare providers can ensure that Natalie has access to the resources and support she needs to achieve optimal health and well-being for herself and her child.

References
Miller CJ, Wicksell RK, Olsson GL. The role of collaborative care in improving patient outcomes in fibromyalgia. Pain Manag. 2018;8(2):103-110.

Li J, Li J, Liang X, Liang Y, Lu J, Chen Z. Effectiveness of collaborative care for depression in China: a systematic review and meta-analysis. J Affect Disord. 2018;234:230-239. 18

Smith SN, Rost KM, Nutting PA, Elliott CE, Dickinson LM. A new method for assessing primary care delivery changes associated with the integration of behavioral health: the QUERI Collaborative Care Implementation and Evaluation Framework. Implement Sci. 2018;13(1):39.

Henke RM, Zaslavsky AM, McGuire TG, Ayanian JZ, Rubenstein LV. Clinical inertia in depression treatment: a cross-sectional study of patients receiving care in the Veterans Health Administration. BMC Health Serv Res. 2019;19(1):790.

Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: telemedicine work group of the American Academy of Neurology update. Neurology. 2020;94(1):30-38.