Reference no: EM133543365

Case Study

You are admitting a new patient to the antepartum unit. Melanie, who is 7 months pregnant, has arrived after a call from her physician's office regarding concerns of skin irritation and possible urinary tract infection. Melanie is sitting in a wheelchair and is in obvious discomfort with facial grimacing. You ask if she can stand on a scale to be weighed and she says, "I don't think your scale will hold me." Melanie, who is very obese, struggles to rise from the wheelchair and move toward the scale, holding the foot of the bed as she walks. You find she weighs 475 pounds and that her height is 66 inches.

1. How do you calculate Melanie's body mass index? What table could assist you in your calculation?

2. You proceed to measure Melanie's blood pressure, using the largest cuff available. Why is it important to choose an appropriate size cuff in Melanie's case?

3. You continue the admission assessment. Melanie's clothing appears neat but she has pungent, foul-smelling body odor. Perspiration is visible on her forehead and upper lip although the environmental temperature is comfortable. She has long, artificial fingernails and multiple rings on her fingers. You assist Melanie as she removes her clothing and dons a hospital gown. You observe that she has rashes in the skinfolds of her arms, in her axillae, and under both breasts. Her abdomen is very pendulous, and you suspect that the rash extends under her abdomen, into her groin, and between her thighs. The skin appears reddened and moist, and the rash has sharply demarcated borders. What questions should you ask that relate to the rashes you observed?

4. What do you suspect is the cause of and possible reasons for Melanie's rashes?

5. As you continue your skin inspection, you identify a stage II pressure ulcer over the coccyx. What are the stages of pressure ulcers and their characteristics?

6. What are risk factors that predispose Melanie to pressure ulcers?

7. Melanie says she needs to urinate. "I just can't wait to get to the bathroom when I have to go, but I hate to urinate as it burns so much." You assist her to the toilet.

8. What health history questions will you ask to focus on Melanie's urinary symptoms?

Update: The wound care nurse was called to see Melanie and has ordered a bariatric bed with pressure mattress overlay, prescribed antifungal medications for the rashes, and initiated a wound care protocol for the pressure ulcer. She is to be taken to a walk-in shower daily for bathing and dressings to be placed between all skin folds after medications applied. How does Melanie's pregnancy affect her GU system?