The following is a case simulation involving a patient initially encountered in Labor and Delivery. While the initial encounter occurred in a specific setting, this particular case will evolve and include transitions to various specialty areas over the healthcare continuum.
Encourage open discussion from nurses that represent a variety of specialties.
Promote learning based on the:
details of the case
evaluation of the data
known interventions in order to provide holistic care
Recognize maternal morbidity and mortality as a serious public health issue facing the world.
Introduction
The initial presentation that will proceed is meant to set the tone for the next set of events that will occur. I would like to preface by saying that this particular part of the case is where I have no actual nursing experience so I encourage colleagues who work in this specialty area to chime in with their responses.
Let's keep this lively, but also make sure we are respectful of each other. Remember that we work in different hospitals and protocols may be different. Also, be aware that while the following scenario seems "garden variety", it will get more "exciting" as we move along.
Case Specifics
History / Presentation
EJ is a 32-year old, Gravida 4 Para 2, at 34 weeks and 2 days gestational age. She has no chronic medical problems but admits to current tobacco smoking since age 17. She says that she has been trying to quit and has cut back her smoking to 2-3 cigarettes a day. She lives with her husband and two children ages 3 and 5 in a 2-bedroom apartment.
She receives prenatal care at an urban Federally Qualified Healthcare Center (FQHC). She previously worked as a server at a restaurant but has become unemployed for a couple of months due to restaurant closures from the coronavirus pandemic. She has good family support from her parents and her husband, RJ, who is a delivery truck driver. She is insured through her husband's coverage.
Today, she called her Women's Health Nurse Practitioner (WHNP) when she experienced a gush of watery fluid from her lady parts while playing with her children. She was told to come to OB Triage at the nearby Tertiary Medical Center Antepartum Unit. Upon presentation, she was seen by the OB Triage nurse who found her anxious but well-appearing.
Vital Signs
Temperature: 36.7 degrees C
Heart Rate: 84
Respiratory Rate: 16
Blood Pressure: 112/74
O2 Saturation: 96% RA
Fetal Heart Rate (FHR): 140
Physical / Pelvic Examination
An OB-Gyn resident saw EJ and performed a physical examination that revealed clear, pale yellow, odorless fluid leaking out of her endocervical canal with pooling in the lady partsl vault.
Diagnostic Studies
The OB-Gyn resident performed ultrasonography which revealed:
oligohydramnios
a fetus that is small for its age, without birth defects, in no distress
a placenta that does not cover the cervix
Recommendation
The OB-Gyn team recommended admission to the Antepartum Unit.
Diagnosis
At this point, EJ's diagnosis seems obvious but you are welcome to state it in your response to the thread.
1 - As EJ's nurse, state some assessment findings that would make you concerned.
2 - As the nurse in that unit, what laboratory tests and monitoring procedures would you anticipate in this case, and why?
