Case #2 Maria Bowman
Focus questions – Set I
1. What are the implications of this test?
An abnormal maternal serum alpha fetoprotein (triple screening test) may reflect genetic predisposition for Down’s syndrome (Trisomy 21) or Edward’s syndrome (Trisomy 18). Alpha fetoprotein is also increased in amniotic fluid in pregnancies associated with open neural tube defects (ONTD) such as Spina Bifida that allow the fluid to leak from the fetus into the amniotic fluid. The implications of positive test results sometimes point to a possible termination of pregnancy, or the need for an additional testing.
2. When is this test normally done?
The AFP test is generally done between the 14th and 21st weeks of pregnancy.
3. Since this test was abnormal, what additional tests might the nurse anticipate being ordered?
Abnormal test results of AFP may indicate the need for additional testing. Usually an ultrasound is performed to confirm the dates of the pregnancy and to look at the fetal spine and other body parts for defects. An amniocentesis may be performed to assess for elevated amniotic fluid levels of AFP and other chemicals which may indicate the presence of spina bifida.
4. How might Maria’s cultural background affect the nurse-client relationship and what might the nurse do to become more culturally competent?
Maria cultural background my affect her decision regarding TOP, she may opt not to terminate pregnancy. Nurse can reflect intercultural sensitivity by examining her understanding of the different ways she can behave when she is interacting with Maria, her open-mindedness concerning the differences she encounters while caring for Maria, and her flexibility concerning behaving in unfamiliar ways that are called upon by the norms of Maria’s culture. The nurse should be able to modify specific behavior so that it is appropriate to her client’s culture, so that she will have a greater chance of achieving her outcomes.
Focus Questions – Set II
1. Considering the assessment data, what should the nurse do first? The nurse should inform Maria of risks, benefits, and limitations associated with amniocentesis. Although amniocentesis is considered to be a safe procedure, it is recognized as an invasive diagnostic test that does pose potential risks. Miscarriage is the primary risk related to amniocentesis. The risk of miscarriage ranges from 1 in 400. Miscarriages can occur because of infection in the uterus, the water breaks or labor is induced prematurely. Although extremely rare, it is possible for the needle to come in contact with the baby. Great precautions are taken by using a sonogram to guide the needle away from the baby.
2. What specific information should the nurse give Maria and Tom about indications of a test like this and the procedure itself? Amniocentesis is a diagnostic test that is recommended by PCP following an abnormal triple test result. Inherited or genetic concerns lead some parents to choose amniocentesis to determine if specific genetic disorders may be present in their baby. Amniocentesis is performed to assess fetal lung maturity, establish rupture of membranes, rule out infection, evaluate fetal well-being, or evaluate for chromosomal abnormalities. The nurse should explain to Maria that ultrasonography will be performed just before the procedure to determine the position of the fetus and placenta. The placement of the fetus and placenta is located by ultrasonography to avoid trauma from the needle during the amniocentesis. The mother may experience a sharp pain when the needle enters the skin and again when it enters the uterus. A sample of amniotic fluid is collected through the needle. The procedure takes about 45 minutes, although the collection of fluid takes less than five minutes. The amniotic fluid, which contains cells shed by the fetus, is sent to the laboratory for analysis. Results can take anywhere from a few days to a couple weeks to be returned. The...
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