OB HIGH RISK CASE ANALYSIS CASE SCENARIO: A 30-year-old, gravida 4,…
Question Answered step-by-step OB HIGH RISK CASE ANALYSIS CASE SCENARIO: A 30-year-old, gravida 4,… OB HIGH RISK CASE ANALYSISCASE SCENARIO:A 30-year-old, gravida 4, para 3 at 34 weeks’ gestation by last menstrual period presents complaining of shortness of breath and contractions. She has had no prenatal care during this pregnancy. The patient appears short of breath and anxious. Her blood pressure is 134/78 mmHg, and her pulse is irregular at 100-110 beats/min. Respiratory rate is 26/min. She is admitted to the hospital for evaluation and management. An ECG demonstrates atrial fibrillation and chest X-ray confirms pulmonary edema. Arterial blood gas on 40% Fio2 reveals pH 7.48, Pao2 60,Pco2 27, HCO3 – 18, O2 saturation 90%, consistent with hypoxemia and respiratory alkalosis. An ultrasound confirms an intrauterine gestation measuring 33 weeks with normal amniotic fluid volume. Fetal heart rate tracing is reactive with occasional late decelerations. Diuresis is accomplished with furosemide while oxygen supplementation by face mask is continued to maintain oxygen saturations above 95%. Digoxin is started to control atrial fibrillation and prophylactic subcutaneous heparin is begun. An echocardiogram reveals mitral stenosis with a mean valve area of 1.2 cm2 , left atrial enlargement, as well as mild aortic, mitral, and tricuspid insufficiency, consistent with rheumatic valvular disease. Amniocentesis is performed; fetal lung maturity is confirmed and the decision made to proceed with delivery. Epidural is placed to control pain and therefore minimize tachycardia. A continuous esmolol drip is started to maintain maternal heart rate below 90-100 beats/min. Oxytocin induction of labor was begun and the patient progressed to complete dilatation. Persistent variable decelerations developed, a low-vacuum assisted vaginal delivery was accomplished with delivery of a viable 2600-g infant with Apgars 71 , 95 . Postpartum, the patient continued to improve, Cardiac Disease in Pregnancy with resolution of pulmonary edema and control of atrial fibrillation. She was discharged home on postpartum day 4 on digoxin. Outpatient follow-up with cardiology was arranged for consideration of surgical correction of the stenotic mitral valve.1. What is the possible medical diagnosis for this patient?2. Make a minimum of 3 SOAPIE ( SUBJECTIVE, OBJECTIVE, ASSESSMENT, PLANNING, INTERVENTION, EVALUATION) charting based on this patient’s condition.3. Make a Drug Study on the above mentioned medications.4. Give 3 priority NCPs for this patient.5. What are your Home Instructions and health teachings for this patient? Health Science Science Nursing NSG 335 Share QuestionEmailCopy link Comments (0)
