A 45-year-old patient, sextigesta, with high-risk pregnancy due to maternal chronic renal failure, was admitted to a regional hospital, from a regional hospital, due to threatened preterm labor at week 27+2, with tocolytic treatment.
Personal and Family Background
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Family history without clinical interest
Personal history of UTIs, recurrent lithiasis, Chronic Renal Failure (CRF) in current treatment with daily hemodialysis, secondary hyperparathyroidism and chronic anemia.
At 14 years old she was hospitalized for acute pyelonephritis, starting nephrological follow-up until 41 years old, when she started hemodialysis with tunnelled vascular catheter.
Obstetric formula: G6P2A3.
An eutocic delivery at term prior to hemodialysis treatment.
After starting treatment, she presented three consecutive abortions, followed by a high-risk pregnancy due to CRI that presents a threat of labor 2000 premature from the 25th week of gestation, while in the case of a live birth, 33 weeks due to maternal needs
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Current problem
In the study episode, the pregnant woman was admitted to a regional hospital, from a regional hospital, due to a threat of premature labor at week 27+2 in the third step of Atosibán (8 ml/h).
The initial examination performed by the midwife showed a cervix with 2 cm of dilation, medium consistency, intermediate position and effacement of 50%.
Cefits presentation
No amniotic fluid leak was observed.
The echographic study showed a fetus in cefadime, positive cardiac activity and positive fetal movements.
Biometry was obtained according to gestational age, amniotic fluid and normal placenta, cervicometry 9-10 mm. Umbilical Doppler was within normal limits.
During hospitalization, lung maturation is performed with corticosteroids, as well as monitoring and serial fetal monitoring, maintaining daily hemodialysis cycles of 240 min at a pump rate of 280 ml/min.
The case is evaluated in conjunction with the nephrology service, with a consensus on an expectant attitude; the patient continues to be hospitalized for controls and daily treatment with folic acid, vitamin B12, vitamin D, erythropoietin 40mg.
Blood pressure control remains within normal limits (&#8804; 140; TAD < 90 mmHg), although it has minimal edema.
During hospitalization, she requires two blood transfusions during hemodialysis, due to hemoglobin levels below 8.5 mg/dl. At week 31+1, she begins with little dynamics perceived as painful.
After gynecological examination, the patient starts labor.
Labor is conducted, which develops uneventfully, being an eutocic delivery with live newborn, male 1720 gr and Apgar 9/10, requiring admission to the Neonatal Unit.
Location: immediate without complications.
Nursing care plan
It was performed from the data collection and using the functional patterns of M. Gordon.
Pattern 1: Maintenance-Perception of Health
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You know your diagnosis and prognosis.
-He has no known drug allergies.
-He doesn't report toxic habits.
"He knows his treatment and does it."
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Pattern 2: Nutritional and Metabolic
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Potassium and sodium diet.
-Ingest 500 cc of fluids.
-He has slight swellings in his lower limbs.
-No skin changes.
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Pattern 3: Elimination
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"Anuria."
"A daily bowel movement."
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Pattern 4: Exercise training
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"Slight physical activity is praised, and your children go out every day."
"He performs usual activities independently (housewife).
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Pattern 5: Sleep - Rest
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-Durry 6 hours a day.
She says she can't sleep anymore because she has small children.
"He refers to tiredness, due to the care of his children."
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Pattern 6: Cognitive-Perceptual
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"Aware and oriented."
-He has no difficulty understanding his health process.
Presentative pain from constriction.
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Pattern 7: Self-perception-self-concept
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"She is afraid of the current situation, because of the possibility of her baby's premature birth and the problems that may arise.
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8: Role and Relations
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"He lives with his partner and children."
"Married housewife, he is in charge of family care and household chores.
"Decreased family support, for she is angry and has only her mother and sister in Spain."
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Pattern 9: Sexuality - Reproduction
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"More than two healthy children."
Three consecutive abortions.
"Not worth it."
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Pattern 10: Adaptation and Tolerance to stress
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"He says he is worried, for his admission will be long lasting, and he cannot take care of his children."
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Pattern 11: Values - Beliefs
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"Muslim religion."
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Diagnostic and planning phase
The NANDA, NOC, NIC taxonomy was used for the care plan, with the diagnoses, results and interventions highlighted as follows:
