Nursing Case Study: Emelia Pena

M. H. states that she is generally in good overall health. No cardiac, respiratory, endocrine, vascular, musculoskeletal, urinary, hematologic, neurologic, genitourinary, or gastrointestinal problems.

On November 23, 1993, Doe was seen by an obstetrician, Dr. James Meserow, at the St. Joseph’s Hospital in Chicago. This was the first time Doe was seen by Dr. Meserow, but she had been receiving regular prenatal care throughout her pregnancy. Upon giving Doe the usual check-up, he determined from a series of tests that the baby was under duress due to an issue with the placenta. At this point, it is important to recognize that Doe is a mentally competent woman carrying her first child, and the fetus is currently around 35 weeks. It also important to recognize that Dr. Meserow is a board-certified obstetrician/gynecologist. Dr. Meserow informs both Doe and her husband of the diagnosis and highly recommends either an immediate cesarean section or to induce labor in order to prevent any further potential damage to the fetus due to the lack of oxygen from the compromised placenta. Doe refuses both of the recommendations based on her religious convictions that God will heal her child and keep it safe from any harm, and will, therefore, wait to have a natural childbirth.

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

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She reports a history of back pain, ovarian cysts excision, and breast tumor. She denies chest pain, shortness of breath, or palpitations. Patient reports that her immunizations and preventive care are up to

On today’s evaluation, she is 19 weeks and the fetal measurements overall are concordant. The long bone measurements are within one week of her dates. The amniotic fluid volume is normal, and the cervix is long and closed. A complete fetal anatomical survey was performed and a significant amount of ventriculomegaly/hydrocephalous was identified but no other major malformations were noted at this time, though due to the

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

By dates, she is 20 5/7 weeks and the measurements are concordant. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal anatomical survey was performed and no major malformations were noted at this time within the resolution of the ultrasound equipment.

Crystal is a 20yo, G2 P1001, who was seen for a follow-up ultrasound assessment. The patient’s primary issue is the development of a postpartum cardiomyopathy after her 1st delivery in 2015. She also reportedly had an anti-M antibody but all of her antibody screens have been negative including one 3 weeks ago. She recovered from the cardiomyopathy and overall is asymptomatic. Her BP was normal today at 127/76 and her heart rate was 98. She states that she actually came to triage 3 weeks ago and had an echocardiogram and we obtained this record and ejection f4raciton is normal at 61.5% and no abnormalities were noted on the echocardiogram. She does have a history of a previous cesarean delivery and is interested in a repeat. In addition,

Mr. Martinez a 48-year-old presents with complaints of heart pounding over the last three days. He also complains of SOB and fatigue with exertion. He denies cough, dizziness, light headed, headache, fever, fainting and nausea and vomiting. Patient has hx of tonsillectomy at the age of five. He also has Hx of hypertension and Hyperlipidemia but on prescribed medication. The patient states that he maintains a regular exercise return to manage his symptoms. He denies tobacco or illicit drug use but admits occasion intake of

B: she is 28 week pregnant, with hypertension, headaches, lower swelling of extremities and dizziness.

Review of the medical record indicates that she was admitted to the hospital on 8/12/16 with complaints of intermittent headaches, low back pain and weight loss. She has previously been diagnosed with metastatic cancer involving the lungs, bone, brain, and liver and started to undergo radiation therapy but has not yet undergone any chemotherapy. She has had 10 radiation treatments with Dr Castello who is her radiation oncologist.

1990: Diagnosed with peptic ulcer disease, which resolved after three months on cimetidine. She describes no history of cancer, lung disease or previous heart disease.

I have based this case presentation on a 38year old lady with a fictitious name of Agnes. She is a married lady with no medical or surgical history. She is a non-smoker and non-drinker. This was her first pregnancy and was relatively uncomplicated until week 36 gestation. At 36 weeks gestation, Agnes complained of increased shortness of breath, ankle swelling and paroxysmal nocturnal dyspnoea which mimicked pregnancy related physiological changes. Agnes was referred to the Coronary Care Unit from the national maternity hospital, 12 hours post caesarean section of a healthy baby boy in view of deteriorating condition, tachycardia and increased shortness of breath and leg oedema.