Brorchu Case Study Nursing

The patient has no family history of heart disease or diabetes, however both her parents are on medication for high blood pressure. Her paternal grandmother died of breast cancer at age 47. Her maternal grandmother

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

During our initial assessment of Ms. K.R., the following vital signs were noted: blood pressure was 147/67, temp 36.6 degrees Celsius, pulse 80 beats per min., respiratory rate of 20, pulse ox 99% on room air, a pain score of 8 during contractions, and fetal heart tones had a baseline of 130 over the last two hours. Her labs showed 2+ protein in her urine but she denied any headaches, vision changes, right upper quadrant pain, and no DTRs or colonus were observed. Ms.K.R. seemed to be handling her labor well, with the exception of being in a lot of pain and unable to find a comfortable position.

She had an 8-week ultrasound that confirmed her dates. She now is 11 ½ weeks and is interested in a FTS. The nuchal translucency measurement fell within the normal range. The nasal bone was identified, and there was normal ductus flow. She therefore underwent laboratory testing and the complete result of this screen should be available in the next 4-7 days. If the result of this screen returns with decreased risks, we would recommend a good fetal anatomical survey between 18-22 weeks gestation.

Views today demonstrate a viable singleton fetus at 12 weeks 2 days. Fetal crown-rump length measures 59.2 mm. The best nuchal translucency measurement obtained was 1.8 mm, and the nasal bone was visualized as present. Fetal cardiac activity is visualized. Due to early gestational age, fetal anatomy was not assessed, but 4 extremities are noted. Amniotic fluid and placental location are visualized as normal within limitations of early gestational age. Adnexa are suboptimally seen. No notching is seen on the uterine artery Doppler’s.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. On detailed survey we did note an ONTD that is suspected to be from the lumbar down to the sacral area. There was no skin covering the area and there was no clear evidence of meningomyocele but on transverse imaging of the spine they are significantly splayed. In the intracranial views we did see a lemon and banana sign. The ventricles were upper-normal and prominent, right at 1 cm with dangling choroids.

This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks

On today’s ultrasound, a single living IUP is identified with the fetus currently in cephalic presentation with a 3-vessel cord with normal insertion into an anterior right-sided placenta. Fetal biometry today demonstrates an EFW at the 31%ile for reported gestational age. A detailed anatomic survey is without any notable structural abnormalities; however, portions of the fetal face and heart remain to be well visualized due to the fetal position. There was some concern on outside ultrasound for possible cervical shortening and due to this a transvaginal ultrasound was performed that

The patient is an 18 year old Spanish female who came to the unit on 11/31/2016 at 23:10 complaining of cramping and she had thought that her water had broken. Her pain was a 4 on a scale of 0-10 in her abdomen described as cramping. Upon examination she was dilated to 3cm, 80% effaced and the position of the baby was -2 and vertex. Her membranes remained intact. Her estimated due date was 10/28/2016. This is her first pregnancy. She has no history of abortion or miscarriage. She has had her flu vaccine and tdap vaccine in October, 2016. She has never smoked or done illegal drugs. She is negative for group b strep, hepatitis, HIV, and syphilis, gonorrhea, and chlamydia. She is rubella immune. There is a language barrier between the patient and the staff. The patient and her family only speak Spanish and only knew very little

Angela is a 36yo, G5 P3013, who was seen for an ultrasound evaluation and consultation for AMA. The patient is currently 36 but would be 37 at the time of her EDD. She does have a history of chronic HTN and reportedly is on labetalol 100 mg b.i.d. but in talking to her she has actually not filled the prescription yet and therefore has not started the medication. Her BP was 141/98 on her initial check and on repeat 140/92. Her urine evaluation is negative for protein. She does have asthma but is currently asymptomatic. Based on her height and weight at the start of the pregnancy, her BMI was 44. She also does smoke cigarettes at ½ pack per day. She was counseled on cessation.

On ultrasound today, there is a live fetus in cephalic presentation. We did not full biometry but we did remeasure the head circumference and confirmed that it lagged by 2 weeks. In other intracranial imaging, we did not see overtly dilated ventricles, although they did appear to be somewhat prominent frontal horns. We could not completely visualize the cavum septum

By dates using an EDD of 05/02/17, she is 14 3/7 weeks. The fetal measurements on average are about 9-10 days larger and are symmetrical. The amniotic fluid volume is normal and the cervix appears to be long and closed. There is an anterior LUS fibroid that is about 2 ½ cm in size. A fetal anatomy assessment was performed though limited by the early gestational age. No major malformations were

By dates, she is 24 5/7 weeks and the measurements are concordant. The amniotic fluid volume is normal. A repeat fetal anatomy was performed and further views of the face and diaphragm were seen. Again, due to fetal position and maternal body habitus the fetal heart was not cleared.

On today’s assessment, she is 34 weeks. The amniotic fluid volume is again somewhat increased even beyond last week with an AFI of 32 cm. BPP is 8/8 and the Doppler study is very reassuring and again, the patient has good fetal movement.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. Amniotic fluid is within normal limits. Umbilical artery Doppler was within normal limits. BPP is 8/8. Transvaginal cervical length was 2.1 cm. It did have a small beak and went