Case Study Analysis for Dylan's Pregnancy: Priority Assessments, Urine Findings, Fundal Height, Fetal Heart Rate, Blood Test, and Teaching Points

This case study analysis discusses the priority assessments for Dylan's pregnancy, including improper nutrition, body temperature, respiration rate, diabetes, signs of anaemia, and pulse. It also covers the significance of urine findings, fundal height, fetal heart rate, blood test, and teaching points. The article provides insights into the diagnosis of gestational diabetes, protein in urine, and urinary tract infection. It also suggests medication and teaching points for Dylan to maintain a healthy pregnancy.

Running head: CASE STUDY ANALYSIS
DYLAN CASE STUDY
Name of the Student
Name of the University
Author note

1CASE STUDY ANALYSIS
Answer 1
The six priority assessments by a nurse in her case are – improper nutrition or less iodine
intake, Dylan body temperature check, checking of respiration rate, diabetes check, signs of
anaemia and check the pulse.
After 28 weeks of pregnancy, Dylan has gained only 4kgs of weight. Nurse predicted that
she is not maintaining her diet. Improper diet can affect the baby; the baby might be of short
stature, deaf or disability to think.
Dylan’s body temperature assessed and suggested that during pregnancy, the mother must
have a normal body temperature. The high temperature might affect the baby, or sometimes the
temperature rises because of dehydration, which might cause tiredness in Dylan.
The respiration rate assessed. Even though Dylan can feel baby kicking; however,
recommended keeping proper growth of the baby as she did not gain weight as expected. It is
common among pregnant women for breathing shortness as the baby grows it squeezes the
lungs, and the breathing becomes normal after the baby drops to lower belly part (Barbosa, Silva,
Cerqueira, Novo, Almeida & Novo, 2015).
As Dylan GTPAL result showed G2 T0 P0 A1 L0, it means that her previous pregnancy
was unsuccessful. The reason might be she is suffering from deficiency or any disorder. In this
pregnancy, the nurse must be sure if Dylan has diabetes. As diabetes in the blood affect the child,
and it might lead to miscarriage. The blood glucose kept under control else increased risk of
kidney, spine and heart defects in your newborn.

2CASE STUDY ANALYSIS
In the case study, mentioned that she is suffering from tiredness and exhaustion. Anaemia
is the cause of the above factors. Blood carries the nutrients to the child, so to keep Dylan child
proper health supply of nutrition required.
A mother must have her heart working properly. Therefore, Dylan pulse rate checked to
see if normal. Treat any unusual sign quickly.
Answer 2
Urine findings during pregnancy are sugar, protein, ketone and bacteria. The significance
of these findings are as follows-
Sugar in Urine shows type II diabetes. Women during pregnancy have high sugar content
in their Urine for gestational diabetes (Adam & Rheeder, 2017). The test helps in diagnosing
whether Dylan having diabetes, or she had taken some sugary drink immediately before the test.
Protein in Urine means of kidney or urinary tract infection. Preeclampsia conducted to
see the difference between protein levels early or later level of pregnancy. It complicates about 7
percent of pregnancies, and the women need immediate attention (Farrar, Duley, Dowswell &
Lawlor, 2017). Doctors recommend performing caesarean and induction of labour once
confirmed that the baby is viable.
Diabetic pregnant women have increased the number of ketones in the blood, causing a
severe feeling of nausea. It affects the bay as the bay is not getting enough energy for the diet.
On the other hand, researched that excess ketone in the blood of pregnant women can affect
brain cells of the baby and baby is born with low IQ (Tieu, Middleton, Crowther & Shepherd,
2017).

3CASE STUDY ANALYSIS
Urinary tract infection (UTI) caused due bacteria. If not treated, it makes the vagina
unhealthy. Mother loses red blood cells that can affect both the baby and the mother.
Dylan must be maintaining all the nutrition as she has keep her baby fit and healthy. It is
her responsibility to come for regular check up so that she can underdtand her medical progress.
Answer 3
Fundal height measured with a measuring tape at the uterus top (fundus). The tape
stretched along with the pregnant uterus, and longitudinal measurement taken. The doctor/ nurse
measures the uterus highest point to the top of the symphysis pubis.
Dylan has a fundal height of 29cm on 28 weeks whcih is little above the normal range
24-28cm and assumed she has diabetes, too much water in uterus or she is having twins (Robert
Peter, Ho, Valliapan & Sivasangari, 2015).
Answer 4
Sonography performed if abnormal fundal growth observed.
Answer 5
Steps taken to assess the fetal heart rate are as follows-
 The patient explained that listening to her baby's heart is a part of routine check-up that
help in keeping a track for baby’s health condition (Amant et al., 2015).
 Pregnant women placed in a semi-sitting position with knees stretched (Kiserud et al.,
2017).
 The Doppler device turned ON, and the volume set properly so that sound is heard
 Babies heart sound heard, and compared with the mother’s heart sound

4CASE STUDY ANALYSIS
Answer 6
The fetal heart rate for Dylan felt to be 130bpm. Diagnosis suggested that fetus with heart
rate lesser than 140bpm is a boy. So assumed that Dylan is having a baby boy.
Answer 7
Physician order completes blood test because abnormal red blood cells cannot transport
enough oxygen in the body hence causing fatigue (Amant et al., 2015). Another cause of
exhaustion can be the deficiency of iron, anaemia and low Vitamin B. These together helps in the
growth of red blood cells.
Answer 8
RBC count is very low in Dylan. Pregnant women have low RBC count than the normal
ranging from 3.5-5.5 x 1012/L (Gilbert, Nelson & Greaves, 2015). However, in Dylan’s case, the
count is crucially low; if the blood count is not normalised, then she might suffer from anaemia.
Low RBC might be a sign of poor nutrition, as her body is not getting enough iron; hence RBC
cannot be made. It affects the baby’s growth, or the baby might undergo malnutrition while born.
Low WBC means inflammation or infection. As the platelet count is less in Dylan body,
it leads to the blood clot. Blood clot might lead to miscarriage (Bhardwaj, Mhanna & Abughali,
2020).
Low Hct and Hgb count in pregnancy mean anaemia. Anaemia can lead to postpartum
depression to mother, and there are changes in premature birth that affect the baby’s body
weight.

5CASE STUDY ANALYSIS
The baby with a deficiency in blood supply suffers from a deficiency, causing death or
down syndrome. The premature birth causes poor bone development sometimes, and the baby
might get affected with congenital heart diseases (Chitayat et al., 2015).
As the case study showed that this is Dylan second pregnancy, and her first pregnancy
was in-vitro and was unsuccessful. They can predict it that Dylan does not have healthy uterus.
Second miscarriage might be bad for her future pregnancy.
Answer 9
Medication is anticipated is Folic acid and Iron capsules. Iron and folic acid are both
required from increasing Red Blood cell count (Adam & Rheeder, 2017). The lab result proved
that Dylan is anaemic; hence recommended that she must maintain a normal blood level in her
body.
Answer 10
Teaching points provided to Dylan are-
 Dylan must be told she is suffering from anaemia that might affect Dylan and her baby-
premature birth, malnutrition or miscarriage
 Dylan needs more iron-rich food to increase her blood count. The RBC count in her body
is very less that might lead to a blood clot causing miscarriage
 Dylan must take a daily dose of 30 mg to 60 mg of iron and 0.4 mg folic acid.
 It is highly recommended to take Folic to prevent neural tube defects.
 The nurse might suggest intravenous iron supplement if Dylan is not comfortable with
capsules.

6CASE STUDY ANALYSIS
Answer 11
Four priority teaching provided to Dylan
 Eat foods rich in iron such as chicken, fish, meat and dried beans
 Take foods high in folic acid green leafy vegetable, orange juice and dark beans
 Take foods rich in Vitamin C such as raw vegetables and citrus fruits
 She must go for another blood test after 1 month to check the progress

7CASE STUDY ANALYSIS
References
Adam, S., & Rheeder, P. (2017). Screening for gestational diabetes mellitus in a South African
population: Prevalence, comparison of diagnostic criteria and the role of risk factors. South
African Medical Journal, 107(6), 523. doi: 10.7196/samj.2017.v107i6.12043
Amant, F., Verheecke, M., Wlodarska, I., Dehaspe, L., Brady, P., & Brison, N. et al. (2015).
Presymptomatic Identification of Cancers in Pregnant Women During Noninvasive Prenatal
Testing. JAMA Oncology, 1(6), 814. doi: 10.1001/jamaoncol.2015.1883
Barbosa, I., Silva, W., Cerqueira, G., Novo, N., Almeida, F., & Novo, J. (2015). Maternal and
fetal outcome in women with hypertensive disorders of pregnancy: the impact of prenatal care.
Therapeutic Advances In Cardiovascular Disease, 9(4), 140-146. doi:
10.1177/1753944715597622
Bhardwaj, A., Mhanna, M., & Abughali, N. (2020). Maternal risk factors associated with
inadequate testing and loss to follow-up in infants with perinatal hepatitis C virus exposure.
Journal Of Neonatal-Perinatal Medicine, 1-7. doi: 10.3233/npm-190264
Chitayat, D., Matsui, D., Amitai, Y., Kennedy, D., Vohra, S., Rieder, M., & Koren, G. (2015).
Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. The
Journal Of Clinical Pharmacology, 56(2), 170-175. doi: 10.1002/jcph.616
Farrar, D., Duley, L., Dowswell, T., & Lawlor, D. (2017). Different strategies for diagnosing
gestational diabetes to improve maternal and infant health. Cochrane Database Of Systematic
Reviews. doi: 10.1002/14651858.cd007122.pub4

8CASE STUDY ANALYSIS
Gilbert, N., Nelson, C., & Greaves, L. (2015). Smoking Cessation During Pregnancy and
Relapse After Childbirth in Canada. Journal Of Obstetrics And Gynaecology Canada, 37(1), 32-
39. doi: 10.1016/s1701-2163(15)30360-1
Kiserud, T., Piaggio, G., Carroli, G., Widmer, M., Carvalho, J., & Neerup Jensen, L. et al.
(2017). Correction: The World Health Organization Fetal Growth Charts: A Multinational
Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLOS
Medicine, 14(3), e1002284. doi: 10.1371/journal.pmed.1002284
Robert Peter, J., Ho, J., Valliapan, J., & Sivasangari, S. (2015). Symphysial fundal height (SFH)
measurement in pregnancy for detecting abnormal fetal growth. Cochrane Database Of
Systematic Reviews. doi: 10.1002/14651858.cd008136.pub3
Tieu, J., Middleton, P., Crowther, C., & Shepherd, E. (2017). Preconception care for diabetic
women for improving maternal and infant health. Cochrane Database Of Systematic Reviews.
doi: 10.1002/14651858.cd007776.pub3

9CASE STUDY ANALYSIS