Question

Part 1: An 18 year old Primigravida presents to Labor And Delivery with what appears to be active labor. Upon questioning, you discover she has received no prenatal care. In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for stress, and denies any support system. The Father of the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins - they were too hard to swallow. She has no idea when her LMP was and she relates always being very irregular. * remember LMP is to ask the first day of the Last Menstrual cycle, not when the bleeding stopped*

What other questions are essential for her safe care? What lab values do you need to obtain? What exam findings should you obtain at this time? What education will you provide for her? She asks you how long this will take to have the baby - what is your best response?

Answer 1

1. The other questions are :-

- is she taking any narcotics , NSAIDS

- is she undergoing the prenatal checkups

- has she did the ultrasound

- is she taking the folic and iron tablets

- is she able to fell the the baby like movement , etc

- is she taking any other medicines which might harm the baby

- has she taken the immunizations

- did she had any bleeding per vagina

2. The lab values to be assessed are :-

- blood glucose

- liver function test

- renal function test

- blood pressure

- complete blood count

- protein level in urine and blood

- albumin levels

- pt ,INR levels

-alpha fetoproteins ,beta hCG ,

- amniotic fluid index

3. Fetal heart sound and heart rate , ultrasound , amniotic fluid assessment for fetal well being ,progress of labor , lung maturity , all this would be done to find the fetal status like is there any respiratory depression , any fetal malformation , etc and mothers basic vital signs assessment is done , is shifted for delivery according to the cervical dilation and effacement and if there is any emergency then emergency c - section is done .

4. Health education will be provided to her regarding her and baby well development

- she will be advised to do prenatal checkups ,intake of folic acid ,iron and calcium tablets to present neural tube defects .

- advice her the side effects of taking marijuana for stress as it will cause respiratory depression of the baby and delayed development

- She will be taught about the warning signs and when to reach the hospital

- She will be advised to follow up regularly and for maintaini g compliance of medications .

- she will be advised to take a nutritious reach diet and intake of more fluids and will be taught how to manage vomiting

- advised to not to take any over the counter drugs or any medicine without doctors prescription as they cause harmful effects on the baby .