You have finally reached the last activity to complete this module. Make certain you accomplish the activities below so you can proceed to the next module. For the final report, devise a written plan of care based on the patient case scenarios below. Submit your nursing care plan report in Final Evidence Forum.

Patient Scenario: Molly Sandoval is a 25-year-old G2P1 at 37 weeks with a twin gestation admitted to a birthing room in early labor. She states, if at all possible she wants to have a vaginal rather than a cesarean birth.

CHIEF CONCERN: Contractions began 8 hours ago; pattern has never become regular. Contractions are presently 5 to 20 minutes apart, about 30 seconds in duration. She is having such back pain with contractions she asks to have something for pain relief. Membranes are not ruptured.

FAMILY PROFILE: The client is not employed; she volunteers days at center for cognitively challenged children, which her older son attends. She also volunteers as a waitress in her grandparent’s business at evenings. Her husband works as a garage mechanic. Finances are “tight.” The couple lives in a furnished apartment above a tavern that her paternal grandparent’s own. Marriage is “shaky” due to strain of finances, family disagreements, and “getting married before we knew each other very well.

” HISTORY OF PAST ILLNESSES: She has chronic sinusitis from “allergies.” She had neardrowning accident in neighbor’s pool at age 2 years and revived by paramedics with no apparent sequelae. She had tonsillectomy at age 7 years. She was admitted at 30 weeks of present pregnancy for preterm labor, was treated successfully with magnesium sulfate, and discharged after 4 hours.

HISTORY OF FAMILY ILLNESSES: Her maternal aunt has child with Down syndrome; Molly’s father died of liver failure from alcoholism at age 45 years. Her husband’s family has “many” people with peptic ulcers. GYNECOLOGIC HISTORY: Menarche was at 14 years; cycle duration: 28 days; duration of menstrual flow: 7 days. She had history of secondary infertility for 2 years prior to this pregnancy; pregnancy is conceived with in vitro fertilization.

OBSTETRIC HISTORY: Molly had spontaneous miscarriage 4 years ago. She had previous pregnancy: boy, 8 lb 4 oz, vaginal delivery, born 5 years ago with Down syndrome. Her present pregnancy is conceived with in vitro fertilization. She attended prenatal care intermittently because of finances. Serum analysis is done for Down syndrome and reported as negative. She had no preparation for labor class attended. “Not interested in being brave during labor” is given as her reason.

DAY HISTORY: Nutrition: 24-hour nutrition recall reveals diet high in carbohydrate and low in protein; prenatal vitamin not taken “because of finances” Sleep: Sleeps 6 hours at night; bar downstairs is “too noisy” until after 3 am to sleep before that Recreation: Does not participate in an active exercise program; walks “lots” every evening when she fills in as a waitress

REVIEW OF SYMPTOMS: Reports lower back pains, constipation, urinary frequency, and swollen ankles

PHYSICAL EXAMINATION General appearance: Alert, but distressed and exhausted appearing obese, young adult pregnant female; height: 5 ft 3 in.; weight: 180 lb; blood pressure: 120/75 mmHg HEENT: Within normal limits Chest: Heart rate: 90 beats/min; no murmurs; lungs clear to auscultation; respiratory rate: 18 breaths/min Abdomen: Fundal height: 45 cm; linea nigra present on abdomen Fetus A: Fetal back palpated to be on left of maternal abdomen; head just above the symphysis pubis; fetal heart rate: 160 beats/min Fetus B: Fetal palpated under the spleen, buttocks on right side of maternal abdomen; head not engaged; fetal heart rate: 140 beats/min Uterine contractions regular every 5 minutes, mild intensity Pelvic examination: Diagonal conjugate measured at 12 cm; pubic arch wide; ischial diameter: 12 cm; coccyx movable; cervical dilation: 4 cm; effacement: 20%; station: 0; Bishop score: 9; membranes intact Extremities: Full range of motion; patellar tendon 2+; dependent edema 1+ below ankle on both sides

LABORATORY REPORTS: Hemoglobin: 10.2 g/dl Hematocrit: 31.8% Urinalysis: Negative for protein and trace for glucose; specific gravity: 1.030


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