Nursing Management of Labor and Birth at Risk

Case Studies, Chapter 21, Nursing Management of Labor and Birth at Risk
1. Laura is a 26-year-old G2P1 who had a cesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat cesarean delivery or attempting a VBAC. (Learning Objective 9)
a. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat cesarean deliver
b. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.
c. Describe the management of care for a woman attempting a VBAC delivery.
Antepartum Case Studies 
As you provide answers to the questions in the following case studies below please refer to your Essentials of Maternity, Newborn, and Women’s Health Nursing textbook’s Chapter 19 and 20 to provide you with pertinent information in reference to these cases.
Each of the objectives listed in the following case studies are in reference to those found in the textbook chapters listed alongside the case studies heading.
Please use this document as your template and insert your responses after each question in a different color or font. 
Case Studies, Chapter 19, Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1, 2, 4, and 5)
a. Why is Teresa’s pregnancy considered a high-risk pregnancy?
b. Discuss potential pregnancy-related complications for Teresa.
c. Discuss the potential risks to the babies.
2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 4)

  1. Develop a plan of care for the woman      experiencing preeclampsia and/or eclampsia

Case Studies, Chapter 20, Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations
1. Nikki is a 17-year-old G1P0 at 33 weeks’ gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing have the distinct odor of marijuana and tobacco smoke. You directly ask Nikki if she has been taking any other drugs besides marijuana. Nikki is surprised by the question and denies it. When you explain that you can smell it in her hair and on her clothing, she starts to cry and says, “Please don’t take my baby away from me.” After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking “pot” and cigarettes. She relates that she also consumes four to five caffeinated beverages per day. (Learning Objectives 10 and 12)

  1. Describe      how cigarette smoking, marijuana use, binge alcohol consumption, and      excessive caffeine intake can affect Nikki’s pregnancy.
  2. What      possible affects are there to Nikki’s baby from the maternal ingestion of      these substances?
  3. Describe      the nursing care you would provide for Nikki.