PBL hw help

[yatyu]

Here is the scenario:

Amy, a 32-year-old woman, is accompanied by her husband to the emergency room. She is known to be pregnant for around 4 months and started to have some brownish spotting this morning. This is Amy's second pregnancy. Two years ago, she has her first pregnancy but ended with spontaneous abortion at week 10. This time, she has had some abdominal cramps since last night. Physical examination finds that Amy is having normal body temperature and the cervical os is closed. The couple is very anxious and Amy is very concerned whether this pregnancy is going well. She keeps talking to the nurse, saying that with this pregnancy, she has felt fine all along except for the breast tenderness and frequency in micturition, and unlike the first pregnancy, she had not been having vomiting or morning sickness. She suspects that may not be a good sign again. She also tells the nurse that she has been eating very cautiously, having only the "goodies" like swallow nest, etc., right from the start. Due to fear of having another abortion, she quits her job when she knew she was pregnant, and has been staying in bed most of the time in the last couple of months. She also worries a lot of the hospital acquired infections and refused to stay in the hospital. She prefers to try using Chinese herbs to stabilize the pregnancy and stays at home until delivery.

The pregnancy sustains and Amy gives birth lady partslly at 37 1/7 weeks of gestation to a baby boy weighing 2.7 kilograms. Amy is very anxious about the care of the baby, since she reckons that he is small because he was born 20 days earlier than the expected date. Despite the fact that she is very tired after the delivery, Amy is so excited that she cannot sleep and wants to take care of the baby all the time. She comments to the others that the baby is very precious to her. She gets upset with a swollen scalp found in the baby's occipital area and cries about it.

On the third day after delivery, the baby's swollen scalp subsided. While Amy is planning for discharge from the hospital with the baby, she is informed by the nurse that the baby appears yellow and further investigations are needed. At the same time, the cord blood report confirms that the baby has G6PD deficiency, but has normal T4 and TSH. Amy is stunned by the news, and starts sobbing by her bed. She is looking blank and seems unable to take in the information. The husband comes, and asks what G6PD deficiency is, what it means, and if there are any treatments for the condition. He also expresses concern about the yellow discoloration and wants to know what is to be done. The couple seems lost at the news and you are there to explain the situation to them.

I know there are a lot of hypotheses.......But I want something really interesting and special for my PBL report......What are your opinions about this case? what impress you most in this scenario? Thanks!!!

[EricJRN, MSN, RN]

Sounds like there are several issues that you could cover in your report. Which ones stick out the most to you?

[yatyu]

actually, i want to explore more about postpartum depression...but I dunno what special hypothesis could be set........

[yatyu]

any help??

[augigi, CNS]

I think if you make an effort to outline what you are thinking, lots of people will be happy to point you in the right direction. It's difficult to help with such a broad question.

[yatyu]

i 've made one of the hypothesis:

amy is suffered from postpartum blue and has a higher risk of having postnatal depression.

is it ok??

[yatyu]

Also, I want to ask if her previous experience in spontaneous abortion would increase the her risk to suffer PPD in this time....