NICS PBL Worksheet on Pregnancy Complications

NICS PBL worksheet
PBL Session: Pregnancy
What was one insight you learned from this PBL session? How does
this insight contribute to quality patient care?
Answer) The pregnancy mentioned in the PBL session is a complicated pregnancy case,
where one of the identical twins is underdeveloped. This condition is called the intrauterine
growth restriction. If this condition is seen in twins, one of the foetuses, tend to not acquire the
necessary oxygen and nutrients needed for the efficient growth and development of their
organs, tissues, or due to any infection. The lack of blood flow into the placenta might result in
limited amount of oxygen reaching the foetus. This can cause the foetal heart rate to decrease,
risking the baby’s life (Puccio et al., 2014). Thus, it is crucial to study her condition well and
prepare a customised diet plan mainly consisting of fresh fruits, vegetables, fish and nuts along
with foods having high folic acid concentrations and vitamin supplements, to help the
undernourished twin receive proper nutrients in order for it grow properly inside the womb.
This might be able to avoid premature delivery of the baby and might limit several
complications that the baby might acquire due to its slow development. This would thus also
help improve patient outcome, as this might ensure the reduction in the life risk of twin B and
also reduce pregnancy complications for the mother.

Patients are often complicated. Describe 3 of the major factors identified
in this case which will determine the success of this patient's outcome?
This could include medical diagnoses or nursing diagnoses.
Answer) 3 major factors:
 The patient during her pregnancy had experienced intense itchiness. So the nurses ordered blood
tests which depicted that there is an increase in the bile salt concentration in the blood, which
indicated that she was suffering from cholestasis of pregnancy (Geenes et al., 2014). Thus, the
nurses prescribed Ursodiol to the patient and recommended her to take cool baths, apply certain
creams on the itches.
 After understanding and identifying the complications of the pregnancy, the development of the
foetuses and the condition of their heart rates, were constantly monitored, with the help of
ultrasounds.
 She was also diagnosed with sub chorionic hematoma, which created a mass of blood on the
wall of the placenta of Twin A. Thus, frequent ultrasounds were performed to keep a check on
the development of the hematoma, and the patient was recommended to restrict her movement.
Given the interventions designed by your group, do you feel every
decision was underpinned by logical clinical sense?
Answer) Every decision till the decision to manually break the water to help her push out Twin A,
during a practice session, could be considered as logical. The water could have been broken after the
patient was provided with a practice session. It can also be said that the patient, being the mother of two,
did not require the practice session. Another drawback of the session would be the lack of healthcare
providers and nurses during the whole ordeal. Also, there was a delay in the clamping and cutting of the
cord, because of which twin A had to be taken for observation of any complications because of it.