Answer for NRNP 6552 Week 8 COMMON HEALTH CONDITIONS WITH IMPLICATIONS FOR WOMEN Case # (1, 2, 3 or 4) and Description of the Ca

Identify data provided in your chosen case and any additional data needed.

Objective findings.

Identify findings provided in your chosen case and any additional data needed.

Describe the rationale for each test or intervention with supporting references.

Describe the rationales for your choice of each diagnosis with supporting references.

Describe rationales and supporting references for each.

Social Determinants of Heath (SDoH) for your chosen case.

Describe rationales and supporting references for each.

·         Her only complaint during this visit is weight gain in this current pregnancy.

·         In her first pregnancy, she reports that she delivered a 9 lbs viable male infant via spontaneous vaginal delivery after 10 hours of labor.

·         She also denies any complications during the pregnancy, delivery, and postpartum.

·         There is a family history of diabetes in the paternal grandfather and aunt.

·         There is an additional family history of obesity in the father and mother.

From the history, I would also wish to know:

1.      If the patient has been experiencing polydipsia, excessive thirst, or polyuria.

2.      If there was history of gestational diabetes mellitus in the first pregnancy (Nakshine et al., 2023).

3.      The gestation age at delivery in her first pregnancy.

4.      If the patient has had any prior diabetes mellitus screening.

5.      If the patient engages in any exercises while at home

6.      The kind of diet they take.

7.      If the patient has been experiencing any urinary symptoms such as dysuria, increased frequency, and urgency.

·         Height 5’2”, Weight 170 lbs, BMI 31.1.

·         Head and ENT examination had normal findings.

·         The neck was supple without adenopathy and thyromegaly.

·         The lungs were eupneic and clear on auscultation bilaterally.

·         The CVS exam had RRR, soft systolic murmur Grade II/VI, no rubs noted, 2+ peripheral pulses, and no edema noted

·         The breasts were soft and had fibrocystic changes bilaterally without masses, dimpling, discharge, redness, or inflammation noted.

·         The genitourinary examination revealed uterus size at umbilicus-approximately 24 weeks’ gestation that was size that was non-tender and had fetal heart tones with Doppler.

Additional objective data I would need would include:

1.      Presence of pallor and jaundice on general examination (Yang et al., 2022).

2.      Rate and rhythm of fetal heart tones.

·         A urinalysis to detect presence of proteins and pus cells in urine which may be indicative of proteinuria and urinary tract infections in the current pregnancy.

·         Repeat blood pressure measurements four hours apart to evaluate whether there is hypertension in the current pregnancy.

·         Basic metabolic panel to evaluate renal function and electrolytes for any abnormalities.

·         A liver function test for evaluation of liver function in a setting of possible hypertension in pregnancy.

·         Complete blood counts and hemoglobin to assess for any anemia, leukocytosis, and thrombocytopenia.

·         Obstetric ultrasound to assess for fetal growth, anomalies, and status of placentation.

·         HbA1C levels to determine period of hyperglycemia (Sweeting et al., 2022).

·         GDM is a condition characterized by glucose intolerance and hyperglycemia that is first recognized in pregnancy. The diagnosis is made after a positive OGTT screening test that is done between the 24^th and 28^th week of gestation (Tehrani et al., 2021).

·         Obesity, family history of diabetes, and previous history of delivery of a large for gestation age neonate are common predisposing factors for the development of GDM in this patient.

·         In addition, weight gain during the pregnancy which may have been associated with a sedentary lifestyle due to her current occupation also predispose the patient to the condition.

Type 2 diabetes mellitus

·         An underlying undiagnosed type 2 diabetes mellitus is a common diagnosis that presents with hyperglycemia before 24 week’s gestation (Raets et al., 2023).

·         The predisposing factors to the diagnosis include, obesity and a positive family history of diabetes mellitus.

Hypertensive disease in pregnancy

·         The patient’s sitting blood pressure at 140/84 mmHg, which is slightly elevated for a normal pregnancy (Yang et al., 2022).

·          An advanced maternal age, obesity, and an underlying diabetes mellitus highly predispose the patient to hypertensive diseases of pregnancy such as preeclampsia and gestational hypertension.

·         Encourage weight loss and regular exercises.

·         Nutritional therapy to include foods rich in complex carbohydrates and cellulose (Nakshine et al., 2023).

·         Insulin 10 units subcutaneously OD.

Hypertensive diseases in pregnancy

·         Nifedipine 20 mg PO BD (Yang et al., 2022).

·         Encourage weight loss, exercise, and nutritious diets.

·         GDM is a common medical complication affecting pregnancy that results from insulin resistance and abnormal glucose metabolism.

·         If left unscreened, the diagnosis often complicates a pregnancy and may cause maternal complications such as, diabetic ketoacidosis, neuropathies, retinopathies, and nephropathy (Moon et al., 2022).

·         Other complications include still birth, polyhydramnios, urinary tract and preeclampsia which often complicate the pregnancy.

·         In addition, neonates born from GDM mothers are at high risk of developing neonatal hypoglycemia, macrosomia, hypothermia, jaundice, respiratory distress, and prematurity.

·         The patients are also at risk of developing overt type 2 diabetes if the blood glucose levels are poorly controlled and insulin resistance persists (Tehrani et al., 2021).

Referrals

1.      Endocrinologist

I would recommend a referral to an endocrinologist who would help tailor the patient’s treatment (Harrison et al., 2022).

An endocrinologist would be crucial in evaluating the appropriate medications such as insulin the patient would need to maintain controlled blood sugar levels.

2.      Maternal Fetal Specialist

Patients with GDM are at high risk several complications that may negatively impact their and their unborn child’s health.

As a result, the referral to the maternal fetal specialist is crucial as they ensure the mother is closely monitored thus reducing the incidence of complications such as still birth (Harrison et al., 2022).

Additionally, they can help plan for delivery of the neonate.

3.      Nutritionist

A nutritionist helps advise the patient on the proper diets they need that would help in sugar control (Sweeting et al., 2022).

Patient Education

·         The patient needs to be advised on weight loss, exercise, and healthy diets.

·         The patient needs to be advised on the importance of controlled blood sugar levels and its impact on pregnancy outcomes (Haron et al., 2023).

·         The patient need to be advised on the importance of regular follow-up visits for close monitoring.

·         The patient needs to be advised on the warning symptoms such as vaginal bleeding, drainage of amniotic fluid, lower abdominal pains, and reduced or absent fetal movements as complications of the pregnancy.

·         Patient needs to be advised on the importance of regular blood sugar testing and recording for monitoring purposes.