Case Study 2
Instructions: Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format.
Case Study: Active Labor: Susan Wong
Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.
She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal problem, so they felt they did not want this information.
Reflective Questions
1. As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
2. How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views?
3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?
Active Labor: Susan Wong
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Reflective Questions
- As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
The initial patient assessment and evaluation at the first stage of labor should focus on determining the labor status and assessing maternal and fetal condition at the current stage. It is also important to assess cultural factors to determine how they influence labor and delivery and to develop a patient-centered care plan (Cohen & Friedman, 2020). Susan Wong is a first-time mother hence the main priority data should include her pain levels and information regarding her pregnancy including any issues she had while pregnant. Furthermore, I would assess any discomfort that she has according to the levels of pain she is experiencing. I would also assess any cultural beliefs that she has regarding labor and delivery that could be incorporated into the interventions. Additionally, I would assess the patient’s mental health state mainly because she has a history of abnormal alpha-fetoprotein levels which could be an indicator of birth defects. It is important to know how the news affected the patient as well as her husband to determine the best interventions to meet their mental health needs.
- How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views?
In the case study, I would provide emotional support by meeting with the patient and her family, providing information regarding what happened in the delivery room, and answering any questions. I would provide information in an empathetic and nonjudgmental tone and also avoid making any assumptions regarding the choices the parents made in the prenatal period. I would also give the parents the chance to express their feelings and discuss the way forward based on the severity of the negative birth outcome. According to Mikomangwa et al. (2019), negative birth outcomes can lead to high anxiety levels as parents come to terms with the outcomes. Patients also experience emotional distress although individual reactions are influenced by factors such as religious and cultural beliefs. Therefore, the role of the nurse is to focus on the emotional needs of the patient and her family while at the same time addressing both neonatal and maternal needs.
In my opinion, the choice to terminate or continue with a pregnancy with a high risk of potential anomaly is a personal choice that should be made by the patient. As per Ubel et al. (2018), patients have the right to choose what they feel is best according to their religious, cultural, and other personal beliefs and should be provided with accurate information to inform their choices.
3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?
The Human Genome Project provided healthcare professionals with a high-quality human genome sequence which is easy to access in public databases. As a result, it is easy to search for genetic mutations or variations that may be linked to the development of certain diseases and their progression. Such information will make it easier to predict open spinal defects at early pregnancy stages and to administer interventions that would reduce the problems and improve the health of the child (Dames et al., 2020). Therefore, in the future, detecting gene mutations and variations will be a normal part of maternity care
References
Cohen, W., & Friedman, E. (2020). Clinical evaluation of labor: an evidence- and experience-based approach. Journal of Perinatal Medicine, 49(3), 241-253. https://doi.org/10.1515/jpm-2020-0256
Dames, S., Luctkar-Flude, M., & Tyerman, J. (2020). Edelman and Kudzma’s Canadian Health Promotion Throughout the Life Span (1st ed.). Elsevier.
Mikomangwa, W., OMS, M., Aklillu, E., & Kamuhabwa, A. (2019). Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2397-1
Ubel, P. A., Scherr, K. A., & Fagerlin, A. (2018). Autonomy: What’s Shared Decision Making Have to Do With It?. The American journal of bioethics: AJOB, 18(2), W11–W12. https://doi.org/10.1080/15265161.2017.1409844