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For this Assignment, you will select one of the following case studies below. Then, using the case information and best evidence, complete the chart below. Make sure to address all columns in the chart.

Select a case study of interest to you from the listed scenarios below.

Case #1: Jane

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.

Case #2: Natalie

Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off of work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32 week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and sepsis infections. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32 week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.

Case #3: Katie

Katie is a 17-year-old G1P0. She presents to your office with four missed periods in a row. Katie is a high school student; she is in the 10th grade. She lives with her mother and four siblings. You ask Katie about the father of the baby and she tells you he states “that baby is not mine.” They are not speaking to each other right now. Katie tells you she has been “vomiting a lot and her stomach hurts when she pees.” A urine pregnancy test comes back positive. Katie is so confused because she has been using douching after intercourse as her method of birth control. You ask Katie about the father of the baby, and she tells you he states “that baby is not mine.” They are not speaking to each other right now.

Katie’s past medical history is positive for chlamydia twice in the last year. She was treated at the Health Department but never went back for a follow up. Katie has had no surgeries and is on no medication. When asked, Katie states her last known weight was about 120. Katie’s V/S are BP 110/70, temp 102.5, weight 107. You note enlarged cervical lymph nodes, FHTs are 160, fundal height is 18. Katie’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Case #4: Sara

Sara is a 32-year-old G1P1001. She presents to your office for a 6-week postpartum check following a normal vaginal delivery of a healthy baby girl. Sara had an 18-hour labor with Pitocin augmentation and delivered a 7 pound 2 oz. girl with a second degree laceration repaired with sutures. Sara spent 2 days in the hospital and was discharged home with her infant and husband. Over the last few weeks, Sara has called the office multiple times with questions about breastfeeding and her sutures healing. Upon walking into the exam room to see Sara, you see her baby in the stroller crying and Sara sitting on the exam table crying into her hands.

Complete the following chart:

MN577 Unit 9 Pregnancy Case Review Chart

Description of the case chosen:

Subjective data, identify both given and needed data

Objective findings, identify both given and needed data

Diagnostic or laboratory testing needed with rationales

List of three differential diagnoses with rationales

Medications and or treatments needed with rationales

Patient education needed

Referrals for collaborative care needed with rationales

  • Make sure to address all sections. Do not leave any section blank.
  • Include relevant subjective and physical objective findings.
  • Identify appropriate diagnostic and laboratory testing needed.
  • List at least three differential diagnoses with rationales for choosing.
  • Identify usual medications, treatments, or patient education needed.
  • Determine referrals for collaborative care.
  • Summarize the case study and include any further research, diagnostics, procedures, or follow-up needed.
  • Provide evidence-based references.

please follow the attached copy. just change the words.

Expert Solution Preview

The following assignment requires the analysis and evaluation of different case studies related to pregnancy. As a medical professor, it is important to assess each case and provide appropriate recommendations and treatments based on evidence-based research. The case studies include Jane, Natalie, Katie, and Sara. Each case study presents unique challenges and requires a detailed evaluation of subjective and objective data, diagnostic testing, differential diagnoses, medications, patient education, and referrals for collaborative care.

Case Study: Katie
Description of the case chosen:
Katie is a 17-year-old G1P0 who presents to our office due to four missed periods in a row. She mentions that she has been vomiting a lot, and her stomach hurts when she pees. Despite using douching as a method of birth control, a urine pregnancy test confirms that she is pregnant. When asked about the father of the baby, she mentions that he denied the baby and they are not speaking.

Subjective data, identify both given and needed data:
Given data: four missed periods, vomiting, stomach pain after peeing, the father of the baby denied the baby.
Needed data: information about menstrual cycles, the frequency of douching, the last menstrual period, past sexual history.

Objective findings, identify both given and needed data:
Given data: enlarged cervical lymph nodes, FHTs are 160, fundal height is 18, urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes, positive pregnancy test.
Needed data: blood pressure, temperature, weight, past medical history, allergies.

Diagnostic or laboratory testing needed with rationales:
Culture for sexually transmitted infections, complete blood count, urinalysis, and renal function tests are needed to evaluate any potential infections and diseases that may affect the pregnancy.

List of three differential diagnoses with rationales:
1. Urinary tract infection- Katie’s urinalysis reveals elevated leukocytes, nitrates, and ketones, which suggest the presence of a urinary tract infection.
2. Ectopic pregnancy- In women who engage in unprotected sex without birth control, ectopic pregnancy could occur
3. Preeclampsia- high blood pressure, protein in urine, and headaches are among the symptoms that could occur.

Medications and treatments needed with rationales:
Antibiotics are indicated for an infection. To eliminate the possibility of a current infection, such as chlamydia, a one-time dose of azithromycin might be administered. Paracetamol can be given to treat fever and discomfort. Due to the presence of ketones in the urine, Katie requires insulin therapy to manage her blood sugar levels. The treatment of the ectopic pregnancy would entail the removal of the nonviable fetus by surgery or medication.

Patient education needed:
Katie needs to comprehend the importance of seeking prompt medical attention in the future. She should be taught about safe sex methods and taking care of herself during pregnancy, including diet, fluid intake, and exercise.

Referrals for collaborative care needed with rationales:
Katie requires collaborative care from an obstetrician given her high-risk pregnancy. The obstetrician could be referred to monitor the fetus’s growth, assess the mother’s wellbeing, give prenatal education, and manage complications such as preeclampsia. Counseling services should also be available as Katie’s mental health may be affected.

Summarize the case study and include any further research, diagnostics, procedures, or follow-up needed:
Katie’s case requires several management approaches to ensure that she has a healthy pregnancy and to limit the chances of complications from her previous medical history. Future follow-up appointments to monitor the implementation of lifestyle changes, increased vigilance, and regular medical checkups should be needed. Future prenatal visits recommended to assess the development of the fetus, including performing a routine ultrasound. Further research on the benefits of specific medications to manage the pregnancy complications will be needed.

Evidence-based references:
1. American College of Obstetricians and Gynecologists (ACOG). (2015). Psychosocial risk factors: Perinatal screening and intervention. Obstetrics & Gynecology, 125(5), 1091-1099.
2. Mavrides, E., Allard, S., & Chandraharan, E. (2014). Management of women with recurrent miscarriage. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(3), 379-395.
3. World Health Organization. (2016). Guidelines for the management of pregnancy at primary health care facilities. Geneva, Switzerland: Author.

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