Reference no: EM133385069

Thuy, a 39-year-old primigravida woman. She and her husband, Matthew, of 4 years have been trying to conceive for the last year. The couple was overjoyed with the news of Thuy's pregnancy. The couple moved into their new home in Markham, Ontario two years ago. They also live with Thuy's mother, Binh. Binh arrived in Canada in 1982 as a refugee with her husband and she is recently widowed. Thuy has a younger brother who lives in Vancouver with his family. Matthew is originally from Halifax and his family remains in Nova Scotia. Thuy is a physiotherapist working in an outpatient physiotherapy clinic. Matthew is a high school teacher Thuy, Matthew and Binh are fully vaccinated for Covid-19 and received their booster vaccines last summer. A midwife with a planned hospital delivery will manage Thuy's care. Thuy experienced nausea and vomiting during her 1st trimester. She always enjoyed her physical workouts and had some concerns about the safety of her exercise regimen. After 32 weeks gestation, she began to experience low backache. Thuy had Enhanced First Trimester Screening with a Nuchal translucency ultrasound at 12 weeks and was concerned about the results as her cousin has a child with Down's syndrome and is the same age. Thuy also decided to have Non-Invasive Prenatal Testing. Her pre-pregnancy BMI = 20 kg/m2. Thuy gained 9 kg by 24 weeks gestation, and she is a vegetarian. During her prenatal visits, Thuy expressed concerns about her weight gain and wondered if she was eating properly. Thuy and Matthew were also worried about the effect of Covid-19 on her pregnancy. Binh did receive her Covid-19 bivalent booster this past fall. Thuy is hesitant about receiving additional vaccinations due to her pregnancy, although the rest of her vaccinations are up to date. Thuy was noted to have a Rh-negative blood type. During the last month, Thuy and Matthew attended childbirth classes and developed a birth plan. Thuy decided that Matthew and Binh would be the support persons for her during labour and delivery. Thuy, at 39 weeks gestation, has been in labour for several hours. Matthew and Binh accompany here to the hospital. She arrived at Labour and Delivery Unit as her contractions are now 5 minutes apart and is met by her midwife. She has planned for "natural" childbirth. Her membranes also rupture at this time. Fetal heart rate monitoring showed 2 periods of bradycardia. Thuy's baby girl is born after seven (7) more hours of labour. Thuy also has a second-degree perineal laceration. Thuy is discharged 20 hours after delivery. The baby girl was full-term, weighing 3100 g with Apgars of 7 and 10. Thuy plans to breastfeed her baby. The baby girl passed her first stool 12 hours after birth. Her stool was dark green and sticky. Thuy was concerned that this stool may not be normal. During a home health care visit 3 days after birth by her midwife, Thuy noted her lochia flow increased when she was ambulating. She has not had a bowel movement. Thuy informs her midwife that she has been feeling "down" and very tired since coming home from the hospital 3 days ago. Thuy's mother, Binh, is also helping her by encouraging her to rest for a month and not to eat or drink anything cold as per Vietnamese custom. Thuy feels her infant is having trouble breastfeeding and she is concerned about the latching onto the breast. She tells the midwife that her infant only feeds for about 15 minutes and has also only a few wet diapers and one diaper with a stool per day. Thuy finds she sometimes needs to wake her infant up to feed. Thuy is also struggling with sore nipples and engorgement.

Questions

Tyerman et al. (2023) states that "the nursing process is an assertive, problem-solving approach to the identification and treatment of patient health issues" (p.12), by focusing on the client's unique responses to actual health issues/health concerns or potential health issues/health risks/risks:

1. Identify and describe the three most important risk factors and the three most important health concerns that relate to Thuy throughout the perinatal period. Provide a rationale for your choices.

2. Discuss three important nursing interventions based on the identified risk factors and health concerns discussed in part 2a. Provide a rationale for each intervention.