The Growing Fetus

Activity 1
CA 100
CARE STUDY: A PREGNANT !"AN #T$ C!NCERNS F!R $ER FETUS
Jessica Menendez is a 20-year-old woman who is 20 weeks pregnant. You care for her in an emergency room. She has been stabbed in her upper
abdomen from an argument with her boyfriend.
C$#EF C!NCERN:
!s my baby all right" #hat if the knife hit it"
$#ST!RY !F C$#EF C!NCERN:
$lient and her boyfriend were arguing o%er who should ha%e the last piece of popcorn in a bowl when he stabbed her with a kitchen paring knife.
$lient has felt the fetus mo%e since the incident& mo%ement feels same as always. She states' (! know her body parts are still forming. !f
something is hurt' will a new body part form")
PERS!NA%&S!C#A%:
$lient li%es in one-bedroom apartment. She has a high school education& unable to find employment' especially since she*s been pregnant.
+inances are pro%ided by go%ernment assistance. She names her landlord ,Mrs. -ubins. as her most accessible support person. #hen asked if
she intended to continue relationship with boyfriend' she answered' /e ain0t all bad. Just has a bad temper. She does not intend to press charges
against him for stabbing her.
PAST "ED#CA% $#ST!RY:
$lient had nephrosis as a preschooler& no apparent se1uelae. 2ne pre%ious incident of intimate partner %iolence when a pre%ious boyfriend beat
her and broke her wrist. She had no childhood diseases such as mumps or chickenpo3.
FA"#%Y "ED#CA% $#ST!RY:
Mother died at age 45 of uterine cancer. +ather0s health history unknown. 6n aunt has some kind of heart condition.
PREGNANCY $#ST!RY:
7regnancy planned (to make boyfriend settle down. 8ast Menstrual period9 :;2<. /as had no prenatal care& not taking prenatal %itamins.
6lcohol consumption9 a beer to help me sleep at night& smokes two packs of cigarettes a day& states she takes no recreational or prescription
drugs.
GYNEC!%!G#CA% $#ST!RY:
Menarche at age :: years& mild dysmenorrhea each month. /as been se3ually acti%e since age :4. /ad gonorrhea at age := years& treated at city
health center. >ses a diaphragm for contraception. 6s client trusts her boyfriend to maintain a monogamous relationship' she does not ask him to
use a condom.
RE'#E !F SYSTE"S
?ssentially negati%e& has noticed occasional constipation during pregnancy.
P$YS#CA% E(A"#NAT#!N:
@eneral 6ppearance9 7regnant appearing young adult woman in ob%ious emotional distress from recent accident. $lothing is blood-stained o%er
abdomen.
/??AB9 Aormocephalic. ?yes9 +ollows to all positions of gaze& red refle3 present. Mucous membrane appears pale. ?ars9 Ao redness& BMs
mobile. Mouth9 Midline u%ula& two ca%ities present in lower teeth. +our keloid linear scars' each appro3imately 2 cm long present on left cheek.
$hest9 -espiratory rate9 22 breaths per minute. Ao rales or rhonchi present. @ood aeration all lobes.
6bdomen9 2ne-inch long linear incision type wound present 2 inches abo%e umbilicus at midline& wound oozing slight serosanguinous drainage.
>terus palpable at umbilicus. +etal mo%ement felt by e3aminer. +/-9 :CC beats per minute by fetal heart rate monitor. Mild uterine contractions
present on monitor ,:C second duration e%ery C minutes..
@enitalia9 Aormal female& no discharge or lesions or redness.
?3tremities9 ?cchymotic marks in the impression of a hand present on both upper arms. #ell demarcated ecchymotic marks appro3imately 2 3 4
cm present o%er tibia on both legs.
CARE STUDY )UEST#!NS:
:. Jessica*s last menstrual period was January 2<th. Dased on Aagele*s -ule' you would estimate her e3pected date of birth as
a. 2ctober 20.
b. 2ctober 2<.
c. Ao%ember 4.
d. Ao%ember :0.
2. 6ccording to McEonald*s rule' at :5 weeks' the distance from Jessica*s symphysis pubis to the fundus of her uterus should be
a. less than :5 cm.
b. 20 cm.
c. more than 2C cm.
d. :5 cm.
4. Jessica reported that she smokes two packs of cigarettes a day. Bhe effect of smoking cigarettes on fetal growth is
a. nicotine causes brown lines in bones.
b. smoking results in decreased fetal growth.
c. cigarettes cause abdominal bloating.
d. carbon mono3ide causes fetal acidosis.
=. Jessica has described an instance of intimate partner abuse. !ntimate partner abuse during pregnancy
a. usually decreases so this is an unusual history.
b. generally increases so this is not unusual.
c. almost ne%er occurs in order to protect the fetus.
d. accounts for the maFority of intrauterine deaths.
7age 1 of *
C. Jessica has a maternal alpha-fetoprotein le%el assessed. Bhis is a,n.
a. blood serum test to detect neural tube defects.
b. amniotic fluid test to detect sickle cell anemia.
c. urine test to detect if -h disease will occur.
d. blood test to detect hemophilia in the fetus.
5. 6 second anomaly that can be detected by an alpha-feto-protein le%el is the
a. fetus may be cogniti%ely challenged if the le%el is increased.
b. fetus has a serious respiratory disorder if the le%el is decreased.
c. infant may ha%e a chromosomal disorder if the le%el is decreased.
d. fetus may ha%e an orthopedic problem if the le%el is decreased.
<. Jessica doesn*t take prenatal %itamins. Bhe effect of the fetus not recei%ing enough folic acid because of the lack of prenatal %itamins can be
a. a spinal cord defect.
b. congenital talipes disorders.
c. a blood disorder such as anemia.
d. decreased blood clotting ability in the fetus.
G. Jessica has a fetal sonogram scheduled to assess for fetal health. Defore this procedure' you would instruct for her
a. %oid Fust before the procedure.
b. drink nothing for 2 hours before.
c. lie on her stomach for the procedure.
d. drink 4 or = glasses of li1uid before.
H. Jessica says that she knows that her baby*s body parts are still forming. 6ctually' organogenesis or the formation of fetal parts is generally
complete by
a. = weeks.
b. G weeks.
c. :2 weeks.
d. :5 weeks.
:0. Jessica is concerned her baby will be born early. !f a baby is born before surfactant formation is complete' this can result in
a. cardiac anomalies.
b. polycythemia.
c. respiratory distress syndrome.
d. hypoglycemia.
::. #hich would be the best nursing diagnosis for Jessica"
a. /ealth-seeking beha%ior related to careful precautions taken during pregnancy
b. 6n3iety related to health of fetus following a possibly harmful e%ent
c. +ear that she has harmed the fetus by smoking and drinking alcohol
d. 6ltered body growth of fetus related to possibly harmful lifestyle
:2. !f the placenta were hurt by the stabbing' placental hormone production could be harmed. 6 chief hormone secreted by the placenta is
a. estrogen.
b. androgen.
c. calcium.
d. insulin.
:4. Jessica is ha%ing minimal contractions so she is gi%en a nonstress test. /er test shows an acceleration of +/- o%er :C beats per minute two
times in a :C-minute window. You would interpret her test as
a. reacti%e.
b. inconclusi%e.
c. positi%e.
d. nonreacti%e.
:=. Jessica reports that she has felt the fetus mo%ing since her accident. 6 typical fetus mo%es how often"
a. 2ne time per hour
b. :0 times in 50 minutes
c. 6bout :0 times a day
d. $onstantly after :5 weeks
:C. Bo determine if there is blood in the amniotic fluid from her accident' Jessica has an amniocentesis performed. 6n instruction you would
gi%e Jessica prior to this is that
a. she should %oid Fust before the procedure to reduce bladder size.
b. the dye inserted with the procedure will still be present at birth.
c. the fetal heart rate will be increased :0 beats per minute afterward.
d. she can e3pect labor to start within :2 hours of the procedure.
:5. Bhe amniotic fluid is inspected for color. 6mniotic fluid should appear
a. cloudy because of %erni3 caseosa.
b. green because of meconium staining.
c. the color should look like clear water.
7age + of *
d. slightly yellowed because of skin cells.
:<. Jessica has a biophysical profile done for a baseline measurement. Bhis is
a. an estimate of the date Jessica*s labor is most apt to begin.
b. an estimate of fetal health based on fi%e different assessments.
c. documentation of the fetal heart rate by electrocardiogram.
d. determination of the fetal gender and health status.
:G. Iibroacoustic stimulation is used during the nonstress test. Bhe purpose of this is to
a. wake the fetus by stimulating it with a loud sound.
b. disturb the fetus by shaking the mother*s abdomen.
c. stimulate the fetus by a mild electric shock.
d. drain off ner%ous fetal energy by a %ibrator.
:H. #hen you record Jessica*s fetal heart rate' she says' (Bhat seems awfully fast.) #hat is a typical fetal heart rate"
a. G0 to :20 beats per minute
b. :20 to :50 beats per minute
c. :50 to :G0 beats per minute
d. :G0 to 200 beats per minute
20. 6 test to determine if Jessica*s fetus is mature would be a
a. phosphatidylcholine le%el below < grams.
b. neck circumference of o%er :2 inches on 3-ray.
c. demonstration of a moro refle3 on sonogram.
d. lecithin to sphingomyelin ratio of 2;:.
7age * of *