NURS 6552: The Types Of Tests Discussion Paper

NURS 6552: The Types Of Tests Discussion Paper

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Discussion response 2
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Explain how you might think differently about the types of tests or treatment options your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position. NURS 6552: The Types Of Tests Discussion Paper

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Patient Information:

P.H., 29 yo Hispanic female

S.

CC:” I had a positive home pregnancy test, and I have been exhausted, nauseous, and my breast are tender, so I think Iâ€m pregnant.”

HPI: 29 yo Hispanic female, G6T2P2A2L4 para 4, who presents to the clinic to confirm pregnancy. She states her LMP was 12-10-2021, and she had a positive home pregnancy test on Friday of last week. She reports having a recent increase in fatigue, being nauseated, and breast tenderness over the past few months, which made her think she is pregnant because she felt that way with her previous pregnancies. She delivered vaginally previously, with one forceps delivery at 39 weeks and the others spontaneously, including di/di twins at 35 weeks. History of gestational diabetes with her second and fourth pregnancy. She reports her menses started at age 12 and has been regular, coming every 28 days and lasting for five days. Based on her LMP date of 12/10/21, her current expected delivery date is 09/16/22. She became sexually active at age 18 and has had three sexual partners, including her husband, whom she is in a monogamous relationship with. Negative history of STIs and PAPs. She denies any pain with intercourse, abnormal menses, current vaginal itch, discharge, or burning. NURS 6552: The Types Of Tests Discussion Paper

Current Medications:

Womanâ€s gummy vitamin daily for the past year

Allergies: NKA or sensitivities to latex or food.

PMH: No recent illnesses or past medical history. She is unsure of her immunization status but knows she was fully vaccinated as a child; she thinks they are up to date, with her last TDAP in 2012. She states she has not had the HPV vaccine and did not receive the COVID vaccines or flu vaccine this year.

Her last PAP was in 2018, and she reports it as normal. Never had a colonoscopy or mammogram but performs self-breast exams and states they have been normal.

Soc & Substance Hx: She is happily married to her husband for the past ten years. She lives in a house with her husband and children. She has a high school degree and works part-time at a local restaurant. She enjoys hanging out with family and friends, cooking, and church activities. She has never smoked, vaped, or used any tobacco or recreational drugs. Occasional social ETOH use before pregnancy. She states she has a sound support system from her family and friends, never texts and drives, and always wears her seat belt. She reports a low-stress level, although her kids sometimes make her crazy. She eats a healthy, well-balanced diet and drinks at least a gallon of water/day with an occasional cup of coffee. She states she typically gets 7– 8 hours of sleep a night and tries to go on walks at least four days a week.

Pertinent Fam Hx: Mother h/o HTN. Maternal grandfather had h/o DM2. There is a positive h/o twins in the family. NURS 6552: The Types Of Tests Discussion Paper

Surgical Hx: None.

Mental Hx: No history of anxiety, depression, self-harm practices, and/or suicidal or homicidal ideation.

Violence Hx: No concerns or issues about safety (personal, home, community, sexual—current and historical).

Reproductive Hx: (See HPI) Menarche started at age 12. She describes her previous periods as regular, with a 28-day cycle lasting five days with a medium flow and no dysmenorrhea. No prior use of birth control other than condoms.

ROS:

Constitutional: The patient complained of increased fatigue despite getting good sleep at night. She denies fever, weight gain, and weight loss.

HEENT: Eyes: No reports of vision loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No reports of hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No complaints of rashes, itching, edema, or varicose veins.

Cardiovascular: The patient denied chest pain/pressure, dyspnea, edema, and palpitations.

Respiratory: The patient denied chest congestion, shortness of breath, cough, dyspnea, and wheezing.

GASTROINTESTINAL: Complaints of increased nausea off and on for the past two months. Denies any anorexia, indigestion, vomiting, constipation, or diarrhea. No reports of abdominal pain or blood. NURS 6552: The Types Of Tests Discussion Paper

GENITOURINARY: Denies any difficulty or pain with urination.

GYN: See HPI- She currently denies any vaginal bleeding, abnormal discharge, or signs of contractions.

NEUROLOGICAL: No complaints of headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: Denied any recent injury, muscle pain, leg cramps, back pain, joint pain, or stiffness.

HEMATOLOGIC: No reports of any anemia, bleeding, or bruising.

LYMPHATICS: Denied any enlarged nodes. No history of splenectomy.

Psychiatric: The patient denied recent changes to her emotional or mental status, with no anxiety and suicidality.

Endocrine: The patient denied diabetes mellitus type 1 or 2 but reports gestational diabetes x2.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

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Physical exam: @ 18 weeks

Ht: 5â€5” Wt: 160 lbs. BMI: 26.6 Blood type: O+ (per pt)

Temp: 98.2â€f RR: 20 HR:71 BP:119/84 SpO2: 100% room air

Fundal Height: 2fbbu FHT:150

Constitutional/general appearance: Alert and oriented x3, overall, well-nourished, well-developed pregnant 29 yo with good personal hygiene and in no acute distress.

Mouth: Good dentition, pink, moist oral mucosa. NURS 6552: The Types Of Tests Discussion Paper

Skin: No rashes or lesions. No complaints were voiced.

Neck: supple, no lymphadenopathy, goiter, masses, or thyromegaly.

Respiratory: lung sounds clear bilaterally.

Cardiovascular: SI, S2, regular rate, normal heart sounds, and no murmurs.

Breast: Bilateral darkened areolas, breast tender to palpation, but no masses palpated or changes to nipples.

Abdomen: soft, nontender, no masses on light or deep palpation, no trauma, normal bowel sounds, fundal height measuring two fingerbreadths below the umbilicus, appropriate for gestational age.

Genitourinary/uterus: Deferred at this visit due to the presence of her other children and no other caretaker at this visit and estimated gestational age of 18 weeks.

Diagnostic test & results:

Depression screening tool, EPDS – 4- Negative
Urine pregnancy test – Positive 4/18/2022 – confirmation of pregnancy
Fetal heart rate of 150 by doppler – confirmation of pregnancy
Fundal height measurement two fingerbreadths below the umbilicus, appropriate for gestational age of 18weeks and enlarged uterus with fetus confirmed by abdominal ultrasound, further confirms pregnancy and rules out ectopic pregnancy.
Urinalysis- (normal 04/18/22); color- pale yellow, clear, ph 6.0, specific gravity 1.025, negative for glucose, nitrites, ketones, leukocytes, blood, protein, bilirubin, and urobilinogen.
Urine sent for culture and chlamydia and gonorrhea testing – results pending.
Prenatal bloodwork: BHcg, CBC, Blood type & Rh factor, antibody screen, Rubella titer, HIV, Hepatitis B antigen, syphilis – pending
Fingerstick: glucose = 160 Hgb =11.4
(Hendriks et al., 2020; Lawerence et al., 2020; McIntyre et al., 2019; Peahl et al., 2021)NURS 6552: The Types Of Tests Discussion Paper.

A.

Differential Diagnoses

(Primary) Encounter for supervision of other normal pregnancy, second trimester- Z34.90; Prenatal visits are imperative for optimal maternal-newborn outcomes. Evidence-based research shows that early prenatal care provides ideal opportunities to identify risks and enhance the health of the woman and her child by giving supportive health care and education (Lawrence et al., 2020; Peahl et al., 2021). Since this is the patientâ€s first appointment, she is behind in receiving her prenatal care, so an entire history and physical assessment must be completed with prenatal labs to confirm pregnancy and ensure optimal maternal-newborn results. Therefore, it is my primary and most important diagnosis for P.H.
Procreative counseling and advice using natural family planning-Z31.61: Family-centred maternity care should define quality and safety within a multi-faceted context that includes patient choice, access, experience, and cost-effectiveness (Vedam et al., 2018)NURS 6552: The Types Of Tests Discussion Paper.
Personal history of gestational diabetes – Z86.32: Due to her obesity, family history, and history of gestational diabetes, this mother is at risk for developing gestational diabetes again and will require close monitoring and proper education (McIntyre et al., 2019; Peahl et al., 2021).
Pregnancy-related exhaustion and fatigue, second trimester – O26.812: Part of P.H.â€s CC was increased fatigue. Fatigue is a natural symptom of pregnancy, but prenatal labs, including a CBC to check for anemia and a thyroid panel to rule out hypothyroidism, should be collected at this visit and reviewed when received from the lab (Peahl et al., 2021).
Pregnancy care for a patient with recurrent pregnancy loss – O26.2: Due to P.H.â€s increased BMI and history of previous SAB, she will require close, comprehensive care to reduce the risk of another miscarriage (Quenby et al., 2021).
Ectopic pregnancy – O00.9: A positive pregnancy test may result from an ectopic pregnancy. However, since she has not had any vaginal bleeding since her LMP, denies back, pelvic, or abdominal pain, and does not have a positive history of smoking, PID, previous surgeries, or other ectopic pregnancies, it is unlikely that this is her diagnosis (Hendriks et al., 2021).
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Patient instructed to maintain a balanced diet, focusing on increased protein and water intake while avoiding caffeine and simple carbohydrates.
Instruct pt to wear a supportive bra.
Encourage rest when possible to help with fatigue.
Patient instructed to call the office with any heavy bleeding or abdominal/pelvic pain.
Education provided to increase or at least remain physically active.
Keep a log of nutrition (protein intake) and fetal movement if any is felt.
A return visit will be scheduled in 3-4 weeks for a follow-up and prenatal care, where instructions for gestational diabetes screening at a 26-week appointment will be given.
Call the clinic with any concerns or problems. NURS 6552: The Types Of Tests Discussion Paper