FLOURENCE J.

ZAFRAN N203 A
BSN LEVEL II October 29, 2021

Critical Thinking Exercises:

Situation 1.

Sandra believes she is 8 weeks pregnant, but her obstetrician believes she is closer to 12
weeks of gestation.

Questions:

1. What diagnostic procedure would you advise Sandra to determine accurately her age
of gestation?

Sandra should have a sonography examination because it is the most accurate

method of determining gestational age during the first 8 to 12 weeks of pregnancy. The
length of the embryo or fetus from the top of its head to the bottom of the torso can be
determined at this stage of pregnancy, and the fetus is growing at its fastest and most
consistent rate, allowing for a more accurate gestational age assessment.

2. What fetal structures would be apparent if Sandra is 8 weeks pregnant? If she is 12

weeks pregnant?

By week 8, the crown-rump length of the embryo would be 1.5 to 2 centimeters,

with the head accounting for half of its size. The retinas have started to form. The eyelids
and ears are developing, and the tip of the nose is visible. The arms and legs are in good
shape. Tiny fingers and toes are forming on the hands and feet. Arms can flex at the
elbows and wrists. The umbilical cord can be seen clearly. The heart beats in a regular
pattern. The lymphatic system, as well as the lungs, will begin to form. The main
development of the external genitalia begins, while the brain continues to develop.

During the 12th week of pregnancy, the fetus' head growth has slowed and it is
now much longer in length, measuring around 6 centimeters from the head to the rump
and weighing about 14 grams. The nerves and muscles are now cooperating. The fetus is
now able to make a fist with its hands. The external sex organ is well developed and
indicates whether the animal is a girl or a boy. The cartilage that developed at the time
has already matured and is beginning to transform into bones. To protect the developing
eyes, the eyelids are kept closed until the 28th week.

3. Would any structural anomalies be apparent at 8 weeks? At 12 weeks?

 Yes, it is conceivable. Abnormalities in the fetus can be seen as early as 8 weeks of
gestation. Conjoined craniopagus, for example, can be detected at this term, which is an
abnormality in which twins are joined at the back, top, or side of the head. At 12 weeks,
chromosomal abnormalities can be detected and an individual's risk for Down syndrome
can be estimated.

4. Why is it important to date a pregnancy accurately?

It is critical to accurately date a pregnancy for both the expecting mother and the
healthcare providers. It is beneficial to the mother because she will know when to expect
her baby's birth and make the necessary preparations, as well as the do's and don'ts she
must consider regarding her diet, daily routine, and overall lifestyle. It is necessary for
healthcare providers to have this information so that they can determine when to
perform various screening tests and assessments. This can also aid in the evaluation of
the baby's health at birth and determining whether a better intervention is required in
the event of a problem. It serves as a guideline for when to perform certain prenatal
screenings and if the baby is growing normally.

Situation 2.

Carmel, a 35 year old woman, experienced amenorrhea. Her last period was June 3, 2010.
What should she do after learning that she has delayed menses for weeks now? If
pregnant, compute the EDC of Carmel. By what AOG is she now? What changes in her
body would be observable that shows signs of pregnancy?

a. If her period is late, the first step is to get a pregnancy test from the pharmacy, but if she
hasn't had a period in more than 3 months and she can't figure out what's wrong, she
should see a gynecologist so that she can figure out what's wrong and treat the problem;
in some cases, medication is recommended to get her period started. The doctor may
order tests such as a serum progesterone test and serum prolactin levels to determine
the cause of the delay and recommend the best treatment. Also, depending on what is
causing her period delay, she may need to reduce the intensity of physical exercise, rest,
avoid stress, and eat a varied and balanced diet rich in vitamins and minerals to help
regulate her menstrual cycle.

It is also advised to see a doctor on a regular basis to rule out any potential health issues
or diseases such as polycystic ovaries, endometriosis, anorexia, bulimia, hyperthyroidism
or hypothyroidism, which can cause changes in the menstrual cycle.
 a. EDC of Carmel: (March 10, 2011)

LMP: 6 3 10
Formula: -3 +7 +1
__________________________________________
EDC: 03 10 11

b. AOG: 21 weeks of gestation

c. She may experience physical changes during the second trimester of pregnancy, such as
a growing belly and breasts, Braxton Hicks contractions, and skin changes (melasma). She
may also notice a dark line running down your abdomen (linea nigra). She may also notice
reddish-brown, black, silver, or purple lines on your abdomen, breasts, buttocks, or thighs
(stretch marks), nasal issues, dental problems, dizziness, leg cramps, vaginal discharge
(leukorrhea), and urinary tract infections.

Situation 3.

You are a nurse in a pre-natal clinic. A 16 year old unmarried woman comes in requesting
information about options for an unwanted pregnancy.

Questions:

1. What client information do you need to know before counselling a client about her
options?
 Before we can counsel a client, we must first obtain a detailed health history.

2. What are the possible risks or complications will this teenager experience during
pregnancy?

The possible risks or complications teenager experience during pregnancy are:

 Conflicting development crises

 High risk for hypertension
 High risk for premature labor
 High risk for cephalopelvic disproportion
 High risk for hemorrhoids
 High risk for iron-deficiency anemia

3. What are the risks involved if this client undergo an abortion?

 Adolescent mothers aged 10–19 years are more likely than women aged 20–
24 years to develop eclampsia, puerperal endometritis, and systemic
infections. 4 Furthermore, approximately 3.9 million unsafe abortions among
 girls aged 15–19 years are performed each year, contributing to maternal
mortality, morbidity, and long-term health problems.

4. Write a care plan addressing the physical and psychosocial needs of a client who is
trying to decide whether to have an abortion.

(NCP on the last page)

5. What important Health Education topics would best suit her? Give an outline of the
topics to be covered.

Health Education Outline

I. Introduction to Pregnancy

a. Changes

b. Fetal Development

c. Contraception

II. Unintended Pregnancy

III. Pregnancy Prevention

a. Contraceptive Counseling

IV. Preconception Health Promotion

V. Snapshot of Progress

VI. Choice for Unintended Pregnancy

a. Where to ask help

b. Raising the baby

c. Adoption

d. Abortion
References:

Benoit, B., Meagher, S., Rolnik, D., & Wertaschnigg, D. (2019, November 11). Sonographic

detection of fetal abnormalities before 11 weeks of gestation. Obstetrics and

Gynecology. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.21921

Stages of fetal development - First trimester. (n.d.). Louisiana Department of

Health. https://ldh.la.gov/index.cfm/page/986
 ASSESSMENT NURSING DIAGNOSIS PLAN/OBJECTIVES INTERVENTION RATIONALE EVALUATION
Subjective Cues: Risk for Decisional At the end of the a. Ascertain a. Allows the nurse to At the end of the nursing care:
Conflict r/t Lack of nursing care: circumstances of determine
“Wala ko kabalo pa experience or conception and whether the  The client acknowledged
nurse ug ako ba ning interference with  Patient will response of client/couple has feelings of
ipa abort or dli” decision making acknowledge family/significant explored anxiety/distress related
feelings of other. Encourage alternatives. The to making difficult
Objective Cues: anxiety/distress client to talk about decision to decision.
related to the issues and terminate a
making difficult process used to pregnancy may  The client met
decision. problem solve and have been based psychological needs as
make decisions on an inability to evidenced by
 Patient will regarding problem-solve or a appropriate expression
meet termination. lack of support and of feelings, identification
psychological resources. of options, and use of
needs as b. Assist client to look resources.
evidenced by at alternatives and b. Helps client to
appropriate use a problem- reinforce reasons  Patient displayed a
expression of solving process to for decision and to relaxed manner and/or
feelings, validate the be comfortable calm demeanor, free of
identification decision. Involve that this is the physical signs of
of options, and significant others course she wants distress.
use of as appropriate.
resources. c. Physical presence
c. Remain with the of nurse can help
 Patient will client during client feel
display relaxed examinations and accepted and
manner and/or the procedure. reduce stress.
calm Provide both
demeanor, free physical and d. Some clients may
of physical emotional support. be more affected
signs of d. Refer for by the decision
distress. additional and may require
counseling or additional support
resources, if and/or education
needed. or genetic
counseling.