NU 661 Week 11 Assignment 1 Case Study

Sample Answer

Studies show that approximately 25% of expectant mothers will endure bleeding in the early stages of pregnancy, especially the first trimester (Vandana, 2019). This could result from provoked bleeding, infections, miscarriage, or ectopic pregnancy among others.

This paper focuses on the assessment of a 35-year-old African American married woman by the name of Shannon with a chief complaint of amenorrhea for the past 6 weeks.

Subjective Information From the provided information, the patient presents with a chief complaint of amenorrhea for the past 6 weeks. She however denies discharge, vaginal bleeding, edema, or headache. Her UCG is however positive from a test done last week. She also displayed negative results in urine tests for nitrate, glucose, and proteins.

The patient’s past medical history is reported to be consistent for infertility. She however claims to have achieved the current pregnancy spontaneously. She also has a medical history of hypothyroidism, obesity, and HPV. Currently, she is taking drugs such as Valtrex and Levoxyl.

The patient also reports a history of one pregnancy two years back which led to an early spontaneous miscarriage without any complications. The patient denies using any drugs. She is a career woman married for 7 years. However, during the week 7 prenatal visit, the patient presented with vaginal bleeding for approximately 3 hours with no associated symptoms.

During 29th week prenatal visit, her bleeding had stopped, but she presented with white clumpy vaginal discharge that is itchy with no odor or burning sensation. She however displayed no symptoms, with normal pregnancy during her week 33 prenatal visit, while controlling her elevated blood glucose levels.

Objective Information From the collected lab results, it can be noticed that the patient’s TSH and T4 levels are high above normal limits in pregnancy. Her blood glucose levels are also slightly elevated indicating prediabetes. From her BMI, it can also be noticed that the patient is obese.

During her week 7 and week 29 prenatal visit, her vitals still indicated elevated THS and blood sugar levels of which she continued using PNV and Levoxyl as prescribed.

The fetal heart rate was however within normal limits but to the higher end of 160. During her 33 weeks of the prenatal visit, the fetal heart rate had elevated to 164, despite the pregnancy still being normal.

Additional Questions

• What are your thoughts regarding your weight?
  
• How is this pregnancy different from the last one?
• What makes the bleeding stop?
• And what are some of the physical activities that you enjoy? among others (Brown et al., 2018).
  

Assessment

Miscarriage this can be described as the unexpected end of pregnancy before the 20th week of pregnancy. It is associated with cramping and vaginal bleeding among other factors (Mahajan, 2019).

The patient in the provided case study displayed vaginal bleeding for the first 6 weeks of pregnancy, with a history of consistent infertility. She also has elevated TSH levels which are associated with a high risk of miscarriage.

Ectopic pregnancy This is common in the first trimester where the pregnancy forms outside the uterus. The patient will present with abnormal vaginal bleeding, dizziness, low blood pressure, pelvic pain, and rectal pressure (Mahajan, 2019). The patient in the provided case study was positive for abnormal vaginal bleeding but negative for all the other symptoms.

Vasa Previa- occurs when the membrane containing the fatal blood vessels that connect the umbilical cord and placenta overlie are within 2cm from the internal cervical os (Vandana, 2019).

It is associated with painless vaginal bleeding, fetal bradycardia, and rupture of membranes. Transvaginal ultrasound is needed to confirm this diagnosis. However, the patient in the provided case study only presented with vaginal bleeding and negative for the other symptoms.

Plan

What further assessment and/or diagnostic tests would you want to order?

• Complete blood count (CBC) (Hendriks et al., 2019).
  
• Ultrasonography
  
• Kleihauer-Betke testing
  
• Disseminated intravascular coagulation tests
  
• Tests for infections such as UTI, chlamydia, and gonorrhea.
  

What treatments would you want to order?

• IV fluid resuscitation, starting with normal saline solution 20mL/kg (Hendriks et al., 2019).
  
• Blood transfusion

What education would you provide?

• The patient should be educated on the importance of being hospitalized so that her fetus can be monitored and treated as needed (Hendriks et al., 2019).
  

Would you make any referrals to other providers?

• Obstetrician-Gynecologist (Ob-Gyn)
  

What would her follow-up be?

• Closely monitored after every 2 hours until she is discharged.
  

References

• Brown, D. L., Packard, A., Maturen, K. E., Deshmukh, S. P., Dudiak, K. M., Henrichsen, T. L., … & Glanc, P. (2018). ACR Appropriateness Criteria® first trimester vaginal bleeding. Journal of the American College of Radiology, 15(5), S69-S77. https //doi.org/10.1016/j.jacr.2018.03.018
  
• Hendriks, E., MacNaughton, H., & MacKenzie, M. C. (2019). First trimester bleeding evaluation and management. American family physician, 99(3), 166-174. PMID 30702252
  
• Mahajan, M. (2019). Ultrasonographic Evaluation of First Trimester Bleeding and its Clinical Assessment A Prospective Study. Journal of Medical Science and Clinical Research, 7(6). https //doi.org/10.18535/jmscr/v7i6.22
  
• Vandana, J. (2019). Need of Sonography in Vaginal Bleeding in Early Pregnancy; As a Primary Investigation. Journal of Medical Science and Clinical Research, 7(12). https //doi.org/10.18535/jmscr/v7i12.52