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- Putting It All Together Case Study - OB Case Study - Maternity Patient with Complex Social Hx, Chronic HTN, and No Prenatal Care You are a nurse practicing in an urban hospital setting. A 24-year-old, gravida 1 para 0 woman named Maria presents to the hospital you are working at. She is 34 weeks gestation and having intermittent pelvic pain, which she believes, are contractions. Maria is accompanied by her 39-year-old boyfriend. Social History Maria lives in a mobile home park with her partner and his 7-year-old daughter. She states she was strongly considering giving up the baby for adoption because of “financial and other” reasons. She reports she has not had any prenatal care but has been taking care of herself. She states she has "quit smoking and drinking and is eating daily.” She is not currently working, as she recently lost her retail job and states that “ sometimes learning new things is really hard and things have already been stressful,” so she relies on her partner for support. She states she is not close to her family as there is a history of significant physical and emotional abuse with her mom and stepdad. Physical Presentation and History Maria is exhibiting significant abdominal pain and upon further assessment, she reveals that her pain extends to her L flank. Maria also feels warm to the touch and indicates she has had difficulty voiding recently, and does have a hx of recurrent UTI's, but reports they typically “do not feel like this." As you are assessing Maria, you see that she is very pale, and has notable bruising on her arms, back and legs. Maria is quiet and does not offer information unless asked directly. Her significant other has stayed right next to her since being admitted. Maria's initial vital signs reveal a blood pressure of 188/101, she reports that she has had high blood pressure for a few years and was taking Lisinopril when she found out she was pregnant, but stopped taking it because her partner said it was not safe for the baby. She reports also stopping her antidepressant at the same time. She reports no other underlying health conditions. An ultrasound is ordered for Maria, which confirms a gestation of about 34 weeks, reveals low amniotic fluid and a closed and long cervix. Maria's labs reveal her liver functions to be WNL, her urine analysis reveals no proteinuria but is positive for both WBCs and RBCs. A culture and sensitivity has been sent.

Instructions Use the chart below to answer the questions. Answer Reference Question 1. What are some specific screenings that may be employed with Maria? 2. What patient problems are immediately identifiable in this situation? Answer Reference Question 3. How would you prioritize addressing these problems and why? 4. How might these problems impact the duration of the pregnancy? 5. What are some potential concerns for fetal impact? 6. What further assessment is necessary? 7. What are 2 care planning goals that might be considered for Maria?