The Assignment on Medical Science

Added on -2020-02-24

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The aim of assignment is to provision an evidenced based rationale in case of the patient and
present the collaborative management as a decision maker. The purpose is to well take into
consideration the history pertaining to the case and employ the various strategies that would
aid in the decision making as a senior mid wife associated with the medical case of Venessa.
As Venessa have the fourth pregnancy and the number of births pertaining to visible
offspring’s being three in the case. The intent to bring about the collaborative management
while having the support provisioned with the role of mid wife in the case. The various
activities that would form part of taking decisions and acting in a manner that the pre-
requisites are accordingly handled until the doctor is available. Early Pregnancy
complications are common in medical science, which include pregnancy loss, threatened
miscarriage, ectopic pregnancy, molar pregnancy and hyperemesis (NSW, 2017; Gillon et al.,
2014). Most of the early pregnancy complication cases women are assessed, diagnosed and
managed at early pregnancy assessment units (EPAUs). The manner in which the efficiencies
would be deployed to consider for the team of registered nurses and graduate mid wives is
crucial (AIHW, 2017). The decision making strategies which the assignment would cover
would include the steps which would be taken based on the roles and responsibility of the
senior mid wife.
Ms Vanessa Smith, a 38 year old G4 P3 presents takes her admission to the hospital. Since
the hospital has no facility for NICU or High dependency Unit it is primarily depends on the
emergency caesarean facility with on-call staff system. As the patient has already had
sporadic antennal case outside, there is no record available with the patient or the hospital and
even the patients cannot give any reference of the same (Magee et al., 2014). As documental
evidence, she carried during her time of admission only a copy of her morphology ultrasound
report. The report clearly indicate placenta was reported as situated in the upper anterior
quadrant and clear of the cervical with the confirmation in the report that she is
approximately 30 weeks pregnant. Her blood pressure been checked after thirty minutes from
her admission and found 164/112mmHg. According to the patient, her blood pressure has
always been normal. Some mild abdominal pain been reported, while investigating she
admitted that she used to smoke nearly ten cigarettes a day. Her heart rate has been checked
and found 130bpm. The same has been conveyed to the GP and she has confirmed she will be
reaching hospital within four hours.
The patient is thirty weeks pregnant and of 38 years of age with 130bpm of heart rate, with
clear cervical os. Since there are not much of medical history records, the patients can be
advised for some physical activities as pr the guideline of the American College of
Obstetricians and Gynecologists (ACOG). The patient can adopt the prevalent Centers for
Disease Control and Prevention and recommendation of thirty minutes or more of moderate
considerable physical activity maximum on a regular basis, if not the entire week (Edwards et
al., 2014). Those Physical activities will have end number of positive associated with
pregnancy and delivery. She can get benefits which encompass shorter labor along with the
delivery time, reduced pregnancy-associated complications, and discomfort along with
recovery post-delivery (Shaffer, F. et al., 2014; Briley, A. L. et al., 2014; Mol, B. W. et al.,
2016). Routine physical activity will reduce the pertaining incidence of childhood obesity
along with the hypertension and gestational diabetes (Briley et al., 2014; Mol et al., 2016).
The cardiovascular system pertaining to fetal is responsive to a great extent to maternal
physical activity. Any physical activity linked to maternity at the times of gestation would
have an impact and lower fetal heart rate (HR) along with increased heart rate variability
Physical Assessments (Maternal And Fetal)
Higher intensity activity does associate to lower HR along with the greater overall HRV of
the fetus being developed. Since the guideline has not mentioned anything specific about
physical activities like continuous and non-continuous activities the patient can be advised to
take up certain activities like moderate Resistance training, tasks linked to weight lifting and
interspersed with certain periods of rest (Shaffer et al., 2014; Briley et al., 2014; Mol et al.,
2016). The fetal assessment could have been better judged with the ultrasound in this case.
Even with the consumption of smoking to a greater extent can have a negative impact. She
used to smoke 10 cigarettes a day, in order to assess all. Since we have no report on her
physical activities prior to pregnancy, it is difficult to recommend her anything specific.
However to be more ascertain she can be asked to fill up the Activity Questionnaire (MPAQ)
based on which she can be recommended for continuous (e.g., walking, jogging) or non-
continuous (e.g., weight lifting, yoga) (May et al., 2014; Briley et al., 2014; Mol et al., 2016)
. We can recommend her for tests to determine if she is suffering from any of those. Nausea
in pregnancy, hyperemesis gravidarium, end of the first trimester with the symptoms -
Wernicke’s encephalopathy - resulting from a nutritional imbalance of reduced thiamine,
intravenous rehydration, electrolyte monitoring and restitution, anti-emetics, thiamine
supplementation, non-resolving cases steroid therapy (Serin et al., 2017; May et al., 2014;
Briley et al., 2014; Mol et al., 2016).
The Possible Diagnoses
Many women, almost over 50% suffer from nausea in pregnancy. It is called Hyperemesis
gravidarium which is the inability to maintain hydration and leads to complication like
dehydration and ketonuria. The symptom is nausea and vomiting in pregnancy (Serin et al.,
2017; May et al., 2014; Briley et al., 2014; Mol et al., 2016). Though the percentage is low
among pregnancy however it is something that makes a patient dehydrated, ketonuric,
developing an electrolyte imbalance, (hyponatraemia and hypokalaemia). Those symptoms
developed within the 8 weeks, and are directly associated with the levels of HCG, which tend
to be evident at the end of the 1st trimester earlier to the settlement of second trimester (Serin
et al., 2017; May et al., 2014; Briley et al., 2014; Mol et al., 2016). Patients who have nausea
or associated weakness along with the symptoms of vomiting have greater discomfort in
swallowing. The morning sickness along with the nausea at the pregnancy tends to be
harmless. The extremity of morning sickness Hyperemesis Gravidarum pertains to the
extreme form of morning sickness that is accompanied with severe vomiting (Serin et al.,
2017; May et al., 2014; Briley et al., 2014; Mol et al., 2016). The diagnosis is based on the
medical history of the patient. The physical examination is considered significant in the case.
The signs of HG with great prominence are monitored with the examination done. the
additional tests would also be needed in case to rule the problems associated with
gastrointestinal concerns. The appropriate medication with the drugs - Promethazine or
meclizine can be best resort (Garland et al., 2015; Serin et al., 2017; May et al., 2014; Briley
et al., 2014; Mol et al., 2016). The patient can be proposed for pathophysiological tests to
determine hyperemesis. It is related to the HCG (human chorionic gonadotrophin).

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