Medical Case of Venessa and Present the Collaborative Management

Question: Discuss about the Medical Case of Venessa Smith and Present the Collaborative Management. Answer: Introduction The aim of assignment is to provision an evidenced based rationale in case of the patient and present the collaborativemanagement 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 offsprings 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 th e 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. History 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 t hat 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. Observations 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 (HRV). 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, jogg ing) 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 - Wernickes 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. Th e 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). There is a very rare case of complication called Molar pregnancies. This case is found among one out of seven hundred (1:700). This complication happens does take place in case of an abnormal conception as the case may be (Denno et al., 2015; Serin et al., 2017; May et al., 2014). (Jurkovic et al., 2015; Gillon et al., 2014). Investigations Motherhood is a dream for every woman and for that they take all possible means to ensure the birth of a healthy baby. Unfortunately there are cases where a women need to face some unexpected complications. It is advisable in general for every woman to go through active follow-ups and undergo necessary medical investigation when they receive the report confirming pregnant. It is even advised to take up necessary steps during the planning phase of family expansion (Heitmann et al., 2016; Jurkovic et al., 2013). It is very important to remember that each case is individual, all circumstances are different and proper information about the risk and benefits needs to be conveyed to the patients in advance with proper guidance with all available treatment options (Heitmann et al., 2016; Jurkovic et al., 2013). The role pertaining to EPAU along with open access does tend to aid in terms of regular scanning being conducted. Open access and choice in care options has also been advocated as he lping women to feel more in control of their treatment and reducing post-treatment rates of anxiety and depression (Mitchell et al., 2017; Cirillo Cohn, 2015; Fan et al., 2014). The baby along with the parent mother has to take care of her health. It is also crucial that for patients who have a case of an ectopic pregnancy, the relevance of ultrasound in subsequent pregnancies is important as it would in turn aid to exclude a recurrence. There are cases where pregnancy complications are found. Early pregnancy of complication during the advance stages of pregnancy (Cirillo Cohn, 2015; Fan et al., 2014). The units provide a detail report with specialist investigations (scan, HCG), on the nature of complication and a guideline on how to co-ordination and dealing. The EPAU does enable to a greater extent, the continuity of care along with the needed medical administrative coverage. The early pregnancy assessment has the risk of heavy bleeding from vagina. The abdominal pain also shoots up and the visual examinations hold greater significance (Cirillo Cohn, 2015; Fan et al., 2014; Creanga et al., 2015). The examination done by the nurse has to be recorded along with other medical conditions. The internal scans done are of great help too. Along with the ultrasound done, the blood test also might be needed to rule out any further complication and risk factors associated with infections (Smolowitz et al., 2015; Lavin et al., 2015). This is accepted by the medical science globally as the most cost effective while streamlining investigations. For the females who have the case of previous pregnancy being complicated, this service tends to be significant too for ongoing support in the case of future pregnancy (Cirillo Cohn, 2015; Fan et al., 2014). Unfortunately there are the healthcare services that fall under ever increasing pressure just in order to reduce costs t he open access would not be deemed to a greater extent as a financially viable service. It is crucial that viable investigations do take place and results are well explained (Creanga et al., 2015; Cirillo Cohn, 2015; Fan et al., 2014). It is considered significant that patients are given appropriate education along with the efforts from support groups. Management Prioritizing patient care is essential as there can be the risk of unexpected that always prevails. With the appropriate patient care done based on the documents which reflect the background (Smolowitz et al., 2015; Lavin et al., 2015). As Vanessa has had sporadic antenatal care elsewhere, it is necessary that the needed treatment going ahead would require the additional care which has to be well managed. It is important that the treatment pre requisites are well adhered (Smolowitz et al., 2015; Lavin et al., 2015) Communication And Documentation The importance of communication with the patient along with the family cannot be ruled out. It is very important the patient and the family does get to know the complications if any and the treatment. With the blood pressure reports and ascertaining the habit of the patient, it was crucial to step in and make the patient and the family understand the ill effects and the risks pertaining to the serious cigarette smoking by Vanessa. As she is 30 weeks pregnant, the mild abdominal pain she is getting needs to be well comprehended. The reason for the pain and by carefully examining the morphology ultrasound, it has to be well made understood to Vanessa that the fetal heart rate stands to be normal between 120 -160 beats in a minute and the same needs to be communicated. Also that in her case, the fetal heart rate being 130 bpm is normal. The documentation that would need to be well kept in order is the assessment of ultrasound and the record of blood pressure, fetal heart rate along with the medical condition to be well documented before the doctor arrives. Referral Requirements And Support The referrals to other service providers would not be needed in the case. With the investigation done and the medical records in place, the important issue that has to be considered is the effective coordination with the team to monitor the patient. The local support workers would need to have a consultation with the senior staff. Conclusion Having a healthy baby is the dream for all women. In case of Vanessa, the report clearly does indicate that the placenta was reported as situated in the upper anterior quadrant and she is 30 weeks pregnant. There is due care and diligence which is expected to be well delivered to avoid and risks and uncertainties taking place. Thecollaborative management approach in well coordinating the activities and the decision that needs to be taken as part of the care service provisioned is crucial in the case. Vanessa also has got done the sporadic antenatal care elsewhere, it is necessary that the needed treatment going ahead. The significance of communicating with patient is crucial .The various activities would encompass taking decisions along with acting in a manner that the pre-requisites are accordingly handled until the doctor could have been available. Early Pregnancy can have complications associated and are common in medical science, which include pregnancy loss, threatened miscarria ge, ectopic pregnancy, molar pregnancy and hyperemesis. The family of patient too needs to be educated on the concerns and development. With the blood pressure reports and ascertaining the habit of the patient, it was crucial to step in and make the patient and the family understand the ill effects and the risks. The complications in early pregnancy have to be well attended and the position of mid wife involves greater roles and responsibility too. References AIHW (2017). Our Services. Retrieved from:https://www.aihw.gov.au/ Briley, A. L., Barr, S., Badger, S., Bell, R., Croker, H., Godfrey, K. M., ... Patel, N. (2014). A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial.BMC pregnancy and childbirth,14(1), 74. Cirillo, P. M., Cohn, B. A. (2015). Pregnancy Complications and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort.Circulation, CIRCULATIONAHA-113. Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., Callaghan, W. M. (2015). Pregnancy-related mortality in the United States, 20062010.Obstetrics Gynecology,125(1), 5-12. Denno, D. M., Hoopes, A. J., Chandra-Mouli, V. (2015). Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.Journal of Adolescent Health,56(1), S22-S41. Edwards, J. G., Feldman, G., Goldberg, J., Gregg, A. R., Norton, M. E., Rose, N. C., ... Watson, M. S. (2015). Expanded carrier screening in reproductive medicinepoints to consider: a joint statement of the American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, National Society of Genetic Counselors, Perinatal Quality Foundation, and Society for Maternal-Fetal Medicine.Obstetrics Gynecology,125(3), 653-662. Fan, X., Rai, A., Kambham, N., Sung, J. F., Singh, N., Petitt, M., ... Gambhir, S. S. (2014). Endometrial VEGF induces placental sFLT1 and leads to pregnancy complications.The Journal of clinical investigation,124(11), 4941. Garland, E. M., Celedonio, J. E., Raj, S. R. (2015). Postural tachycardia syndrome: beyond orthostatic intolerance.Current neurology and neuroscience reports,15(9), 1-11. Gillon, T. E., Pels, A., von Dadelszen, P., MacDonell, K., Magee, L. A. (2014). Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.PLoS One,9(12), e113715. Heitmann, K., Solheimsnes, A., Havnen, G. C., Nordeng, H., Holst, L. (2016). Treatment of nausea and vomiting during pregnancya cross-sectional study among 712 Norwegian women.European journal of clinical pharmacology,72(5), 593-604. Jurkovic, D., Overton, C., Bender-Atik, R. (2013). Diagnosis andmanagement of first trimester miscarriage.BMJ,346, f3676. Lavin, M., Harper, E., Barr, N. (2015). Health information technology, patient safety, and professional nursing care documentation in acute care settings.OJIN: The Online Journal of Issues in Nursing,20(2). Magee, L. A., Pels, A., Helewa, M., Rey, E., von Dadelszen, P., Audibert, F., ... Firoz, T. (2014). Diagnosis, evaluation, andmanagement of the hypertensive disorders of pregnancy: executive summary.Journal of Obstetrics and Gynaecology Canada,36(5), 416-438. May, L. E., Suminski, R. R., Berry, A., Langaker, M. D., Gustafson, K. M. (2014). Maternal physical activity mode and fetal heart outcome.Early human development,90(7), 365-369. Mitchell?Jones, N., Gallos, I., Farren, J., Tobias, A., Bottomley, C., Bourne, T. (2017). Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta?analysis.BJOG: An International Journal of Obstetrics Gynaecology,124(1), 20-30. Mol, B. W., Roberts, C. T., Thangaratinam, S., Magee, L. A., De Groot, C. J., Hofmeyr, G. J. (2016). Pre-eclampsia.The Lancet,387(10022), 999-1011. NSW (2017). Maternity - Management of Early Pregnancy Complications. Retrieved from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_022.pdf Serin, S. O., Karaoren, G., Okuturlar, Y., Unal, E., Ahci, S., Karakoc, E., Ucak, S. (2017). Thiamin and folic acid deficiency accompanied by resistant electrolyte imbalance in the re-feeding syndrome in an elderly patient.Asia Pacific Journal of Clinical Nutrition,26(2), 379. Shaffer, F., McCraty, R., Zerr, C. L. (2014). A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability.Frontiers in psychology,5. Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., Wood, L. (2015). Role of the registered nurse in primary health care: Meeting health care needs in the 21st century.Nursing Outlook,63(2), 130-136.