Understanding Pregnancy Complications: A Case Study of Kelly

Bachelor of nursing 1
Bachelor of Nursing
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Introduction
Pregnancy is a critical state which requires a lot of care and carefulness. Pregnancy can
come along with mild, as well as severe complications (Bansal et al., 2016, p. 82). This may be
due to previous illnesses, health complications, and injuries or present diseases and injuries. A
case of Kelly is presented where she is in her 18th week of pregnancy, and she has sciatica and
hyperemesis. Sciatica is characterized by pain that occurs from the lower lumbar spine to the
thigh (Baloh, 2019, p. 27). The pain may occur on both legs, the buttocks, and the hips. On the
other side, hyperemesis is a health condition that occurs during pregnancy and is characterized
by extreme nausea, vomiting, and loss of weight (Paddock et al., 2019, p. 15). Kelly is in her
second pregnancy, and she still had sciatica and hyperemesis in her first pregnancy. She has been
taking medicine to reduce these conditions, but there seems to be no change; the pain tends to
show signs of increasing despite the administration of the drugs. Her medical history shows that
she developed severe viral hepatitis ten years ago, which resulted in permanent liver dysfunction.
This piece of work discusses some of the issues concerning Kelly and her health conditions.
There are several reasons as to why Kelly’s sciatica has increased in her pregnancy.
Baloh (2019, p. 26) argue that sciatica in pregnancy may be caused by gain of weight, as well as
an increase in the retention of fluids. This gain of weight and the fluid increases pressure on the
sciatic nerve. The pressure forces the sciatic nerve into the pelvis, which makes it be compressed.
The compressing of the sciatic nerve is what causes extreme pain during pregnancy. This may be
the case which is happening to Kelly, since an increase of weight may be a common occurrence
during pregnancy. Additionally, Kelly’s sciatica may be caused by the imbalance of weight
between the front and the back of her body. Pregnancy results in an increase in the size and
weight of the front abdomen due to the growth and development of the embryo developing in the

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womb. Pregnancy also makes the breasts to enlarge in size as well as in size. The enlarging
lower front abdomen and the breasts make the front to be more substantial than the back. The
back, therefore, may tend to bend a little, stretching the lordotic curve (Ropper and Zafonte,
2015, p. 1242). Thus, the muscles in the buttocks and the back are forced to tighten, hence
making the sciatic nerve to be pinched. This may be one of the contributing factors to sciatica
which Kelly is experiencing. Moreover, Kelly may be experiencing sciatica due to the expanding
uterus (Pinto et al., 2017, p. 4248). It is common for the uterus to expand to create sufficient
surface area for the growing embryo. The enlargement of the uterus may force the sciatic nerve
downwards on the lower part of the spine. When the sciatic nerve is forced downwards, it
experiences force and pressure from the enlarging uterus hence resulting in pain. The intensity of
the pain depends on the force exerted by the uterus. It is possible that the effect of sciatica which
Kelly is experiencing is as a result of the enlargement of the uterus.
The permanent liver failure which Kelly suffers from might have impacted on the
effectiveness of the drugs administered such as metoclopramide and paracetamol. The liver is
significantly known for the hepatic first-pass metabolism. In this first pass metabolism, the liver
has the function of reducing the bioavailability of a drug (Choe et al., 2017, p. 4). When the
paracetamol and the metoclopramide are ingested into the gastrointestinal tract, they are
absorbed into the liver. Metabolism takes a significant role in the amount of drug to be circulated
into the bloodstream. In the case of Kelly, where the liver is not functional, there is a possibility
that the drugs would not be released into the bloodstream (Tian et al., 2016. p. 541). That is,
since the liver is the organ that releases drugs into the bloodstream, there may lack a possible
pharmacokinetic process taking place. The drugs may be retained in the liver and fail to be
released to the bloodstream. Failure to release the drugs to the bloodstream means that they

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would not have an impact on the intended part (Almazroo et al., 2017, p. 16). Sciatica and the
hyperemesis would not be reduced since the drugs have not been released to the problematic
body parts. This may be a possible reason as to why the medications administered to Kelly, such
as paracetamol and metoclopramide, do not seem to bring about any positive impact.
Considering how the metoclopramide is administered in Kelly, there may be a better way
which would lead to a more significant impact on her hyperemesis. The hyperemesis that Kelly
has may be related to sciatica, which brings about pain on the back. This is because nausea and
vomiting is also caused by pain. These conditions may be affected by the method of drug
administration that is done to counter them. Gangmei et al. (2017, p. 123) argue that the
administration of a drug intravenously is more impactful than oral administration. By
considering the possibility that the permanent liver failure may be a cause of the inefficiency of
the drugs, it may be better to use intravenous drug administration (Faridaalaee et al., 2015, p.
70). This is because the liver limits the amount of drug that is released to the bloodstream and
also may make the drug fail to be released fully when it is dysfunctional. The drugs which are
administered intravenously do not undergo hepatic first-pass metabolism (Ohkura et al., 2016, p.
44). This means, therefore, that the liver dysfunction would not obstruct the intravenous
administration of metoclopramide because the drugs are released directly to the bloodstream.
The drug would hence, bring a positive impact, and the condition of hyperemesis improve.
Jokar et al. (2018, p. 1833) conducted a study to compare the efficiency of both
ondansetron and metoclopramide. The study involved two groups of patients where one group
received metoclopramide and the other ondansetron. The results showed that the participants
who used metoclopramide had 43.3% incidence of nausea while those who used ondansetron had
33.3% incidence of nausea (Zamani et al., 2015. p. 137). The findings further showed that the