Adventist Medical Center Collage

San Miguel, Iligan City

School of Nuring
Level 2 RLE

Case Presentation

Patient Scenario, Chapter 20, Nursing Care of a Family Experiencing

a Pregnancy Complication from a Preexisting or Newly Acquired
Illness

A WOMAN WITH EARLY PREGNANCY CONCERNS

Paula Taylor is a 38-year-old, G1P0 seen during her 12th week of pregnancy. She
was diagnosed as having sickle-cell anemia as a child.

CHIEF CONCERN:
“I can’t sleep at night, I am so short of breath.”

HISTORY OF CHIEF CONCERN:

The client entered pregnancy without any feeling of shortness of breath. Since 2
weeks ago, she has been extremely fatigued, has mild constant swelling in her
ankles, a persistent cough, inability to walk upstairs without becoming breathless,
and orthopnea so severe at night she cannot sleep without four pillows.

FAMILY PROFILE:
The client is a massage therapist in boutique spa. Her boyfriend is a plumber. The
client states she has to continue working because her husband does not earn
enough to pay the mortgage on their house without her help. The main reason is,
though, she says, “I’ll go crazy without people to talk to. I’m a people person.” She
does not smoke and no alcohol ingestion since pregnant.

HISTORY OF PAST ILLNESSES:

She developed scoliosis as an early adolescent. She has retainer rods inserted to
support her spine.
HISTORY OF FAMILY ILLNESSES:
One aunt has breast cancer; an uncle has arteriosclerotic heart disease. Her sister
has recurrent absence seizures. A cousin has type 1 diabetes mellitus.

DAY HISTORY:
Nutrition: 24-hour recall:
Breakfast: 1 serving oatmeal with raisins; 1 glass orange juice; 1 cup coffee
Lunch: 1 tuna fish sandwich; 1 serving salad; 1 cup coffee
Dinner: 1 pork chop; 1 serving potatoes; 1 serving spinach; 1 cup coffee
Snacks: Eats ice cubes almost constantly to relieve heartburn; has a craving
to eat the “lead” in pencils
Sleep: Tries to sleep 8 hours a night but receives only 3 to 4 hours because of
constant waking with shortness of breath
Recreation: Enjoys talking to chat room on Web site

GYNECOLOGIC HISTORY:
Menarche was at 13 years; cycle duration: 30 days; flow duration: 6 days;
moderately heavy; mild dysmenorrhea. She became sexually active at age 16
years; she had therapy for gonorrhea shortly afterward. She has been using a
diaphragm and vaginal foam for 2 years of marriage.

OBSTETRIC HISTORY:
She had no previous pregnancies. Present pregnancy was not planned but is
wanted. The couple was planning on waiting 3 more months and then starting a
family.

REVIEW OF SYMPTOMS:
She has had three colds since beginning pregnancy; otherwise negative except for
symptoms of chief concern.
PHYSICAL EXAMINATION:
General appearance: Extremely worried and tired appearing pregnant female;
height: 5 ft 4 in.; weight 180 lb; BP: 135/88 mmHg
HEENT: Negative
Chest: Prominent grade 2 diastolic murmur heard at left sternal margin; apical first
heart sound is accentuated; second sound is split; cardiac enlargement
suggested by percussion; heart rate: 96 beats/min; rhonchi heard on lung
auscultation; respiratory rate: 22 breaths/min
Abdomen: Fundal height: 28 cm; linea nigra and striae present on abdomen; FHR:
158 beats/min
Pelvic: Deferred
Rectum: Two 1-cm hemorrhoids present; no bleeding
Extremities: Edema 2+ present on both legs extending from feet to mid-calf
Neurologic: Deep tendon reflexes 2+

LABORATORY RESULTS:
Hemoglobin: 9 gm/dl
Urinalysis: Negative for protein and glucose

Paula is diagnosed with iron-deficiency anemia and congestive heart failure. She is
prescribed digoxin and bed rest.