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Incompetent Cervix

Jennifer, who is 35 years old, is at 20 weeks gestation. She had been brought in complaining of abdominal pain, increased bleeding, back pain, and pressure at the pelvic area. This was her second pregnancy after. Her first child had been delivered preterm at 32 weeks after painless dilation of the cervix. Although the age of the patient and her personal and medical history gave every indication to cervix insufficiency, the physician directed the patient to have a measurement of her cervical length taken through sonography. This indicated that the patient’s cervix was dilated and her cervical length was of 23mm.

Cervical insufficiency can occur due to anatomic abnormalities (Chan et al., 2011). The fact that the patient had a history of a preterm labor places her under risk. Additionally, women above the age of 35 are at risk of cervical insufficiency (Chan et al., 2011). To manage her condition, Jennifer was scheduled for a cerclage procedure, the McDonald stitch, which is preferred by that most clinicians because it is easier to perform and prevent blood loss. Further reading in the management of an incompetent cervix indicates that in some cases women are given progesterone supplementation, especially if they are at risk of preterm delivery (O’Brien et al., 2007).

Follow-up involves counseling the patient on her diagnosis and treatment to ensure that such a case is not recurrent and to make sure that the patient takes the necessary steps in case of a future occurrence. Additionally, the client was advised to limit her daily activities especially those that would put pressure on her pelvic area. Also, the patient was advised to limit sexual activity.

 

Post-Partum Depression

Depression during the perinatal period affects a majority of women, but it is often underdiagnosed. I was involved in taking care of a mother, 32 years old, who was four weeks postpartum with her third baby. The patient had a history of anxiety and depression and was treated with Celexa 40mg. She described her situation as having increased anger outbursts and crying most of the time. She had become disinterested in her daily activities and was experiencing problems connecting with the baby. With the demands of her other two children, she said she felt overwhelmed most of the time. It was becoming hard for her to function in the home environment. I realized that confirming depressive symptoms in assessing postpartum depression is challenging but the first step to intervention. In this case, we used the Edinburgh Postnatal Depression Scale (EPDS). Vitally, interpreting the EPDS should be combined with clinical judgment. 

The patient was given Celexa 40mg and placed on psychotherapy every week. Postpartum depression affects the entire family (Earls, 2010; Milgrom & Gemmill, 2014). This affects the baby’s development which can last up to adolescence. At the same time, Segre, O’Hara, Arndt, and Cheryl (2010) say that young children of children of depressed mothers have interpersonal, cognitive, and behavioral problems. The whole family is also involved in the recovery process of the mother. The spouse and the other children in the patient’s case are advised to provide support for her, and in taking care of the baby.

Follow-up care involves the nurse having weekly interactions with the patient and carrying out ongoing assessments to determine that the treatment is working (Belleza, 2016). At the same time, the client is advised on self-care activities to ease the depression. Such activities like walking and having enough rest are important for recovery.

Potential Acute Coronary Syndrome

Robert has suffered asthma, hypertension, and type II diabetes. He is a heavy smoker and a social drinker. His mother died of breast cancer and his father died of heart disease at 45 years of age. In this incidence, he came in hospital complaining of central chest pain which radiated to the jaw. He was under medication: Paracetamol, Omeprazole, Atenolol, and Salbutamol inhaler. Initial assessment, as well as personal and medical history, indicated that this was a case of the potential acute coronary syndrome (ACS). His personal and medical history suggest several risk factors for the condition – family history of heart disease, type II diabetes mellitus, hypertension, and his gender (Makki, Brennan, & Girotra, 2015). Electrocardiography confirmed that case as ACS. Performing ECG aids in risk assessment and in supporting the diagnosis.

The patient was given GTN 400mg and Aspirin 300mg to relieve pain. Additionally, he was placed under reperfusion therapy to restore blood flow. Also, the patient was fondaparinux, and anticoagulation agent to prevent future formation of blood clots. The important consideration in such cases is to ensure that assessment and diagnosis are accurate so that the right intervention is given at the right time. Additionally, I learned that making the correct diagnosis quickly determines the outcomes of the intervention. Follow-up care involved teaching the patient to identify signs of ACS and advised to call for help if he notices these symptoms. Additionally, the client was advised to cardiac rehabilitation which includes physical activity, lifestyle changes, psychological and social support (Jarvis & Saman, 2017). Lifestyle changes for the patient were emphasized since he needed to stop smoking, restrict alcohol intake, control blood pressure, engage in the adequate physical activity, and maintain a healthy diet.

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