Reference no: EM133221426
CASE STUDY 1
Emily is a new client who has scheduled her first appointment with you today to have a full physical and a Pap test. You enter the exam room and greet her. She appears nervous, and when you ask her if she is okay, she says, "I haven't been to see a doctor since I was a kid." You smile and reassure her that everything will be fine-that it's just a routine physical. You note that she has a bruise on her left cheek. You glance over her intake form and see that she has indicated that she is female. She has provided no remarkable medical or family history. In the review of systems, she has marked "painful urination." She has left the sexual orientation and sexual history section blank. In the gynecological section, she has indicated that she has not had a Pap test before and that she has experienced bleeding between periods and vaginal discharge. In the substance use section, she has indicated that she has about 15 drinks per week and that she smokes a pack of cigarettes per day. On the basis of the anthropometric measures taken by the medical assistant, you see that Emily's body mass index (BMI) is 33.
1. How should A nurse respond to a patient leaving the sexual orientation and sexual history section blank?
2. On follow-up, Patient confirms that she is a cisgender and shares that she is bisexual and is sexually active with multiple partners. On the basis of this disclosure and her intake form, which of the following should you screen patient for?
3. On the basis of patient's reported pain during urination, spotting, and vaginal discharge, which interventions should you take?
4. At the end of the visit, what teaching on health promotion should you provide to the patient?
CASE STUDY 2
Estella is a 32-year-old Hispanic woman, married, mutually monogamous with her husband, a G4/T1P1A2L2, and has a BMI of 30. She had gestational diabetes with two of her previous pregnancies that resulted in live births. She is constantly struggling to control her weight and does not feel that she has time to exercise. Her first baby was born at 34 weeks due to preterm labor and her second baby was delivered at term; but she had to have cesarean section delivery due to cephalopelvic disproportion (CPD) and a large for gestational age (LGA) infant. Her past obstetric history is positive for one elective abortion at 14 weeks and one spontaneous abortion (SAB) at 6 weeks gestation. Both of her children are healthy. Estella would like to have another baby. However, she and her husband cannot afford a third baby just yet. She has a history of irregular menses and has been using condoms and withdrawal for birth control.
1. If patient were to become pregnant, which health conditions will she and/or her baby be at risk of?
2. What strategies would help to reduce her preconception health risks for gestational diabetes?
3. What strategies would reduce patient's risks for having a baby with a neural tube defect (NTD)?
CASE STUDY 3
Monica is a 38-year-old, African American woman, G2/T0P0A2L0. Her first pregnancy ended in a first trimester therapeutic abortion. She was unaware that she was pregnant because of her history of heavy and irregular menses. Monica's second pregnancy ended in a fetal demise at 18 weeks. She has a new boyfriend who is also African American. She met him at work; she works as a radiology technician and he works in facility maintenance. She has not been using any method of contraception because she thought her risk of pregnancy was less due to her menstrual irregularity. She worries about hormones causing weight gain. She currently has hypertension and hyperlipidemia and her body mass index is 38. She was adopted and is unaware of her biological parents' genetic risk history. Her internal medicine provider started her on an ACE inhibitor to control her hypertension and a statin to improve her lipid profile. She is a nonsmoker.
Preconception health risks for a 38 yr old african american woman on her first pregnancy. has?
2. As patient does not know her biological family's genetic risk history, what primary genetic risk factor based on her race or ethnicity would you most want to screen her for during preconception?
3. What other preconception health strategies would you recommend for the patient since she is not actively planning a pregnancy now?