Pregnancy presents a unique condition and it is of utmost importance by the care provider to conduct all the necessary assessments not only for the purposes of securing the health of the mother but also that of the unborn (London et al., 2015). The first weeks of pregnancy present a unique phase of pregnancy since most birth defects occur during these initial weeks. Examples of the defects include; neural-tube and congenital defects. This makes it necessary to conduct thorough and comprehensive assessment of the unborn and the mother so as to prevent the occurrence of these conditions. As such, during this assessment, it is of utmost importance to collect both subjective and objective data related to the pregnancy.
Among the areas to consider during this assessment is to understand whether the mother has been on folic acid supplements before and during the first weeks of pregnancy (London et al., 2015). Failure to take folic acid supplements is associated with a higher likelihood of developing neural-tube defects such as anencephaly and spina bifida (London et al., 2015). In the event that the mother had not been on folic acid supplements, it is important to initiate the supplement intake as soon as possible as a proactive measure. On other hand, as part of subjective assessment, it would rewards to ask questions relating to family history with regard to genetic diseases and defects. Knowledge of the family history along this line helps in mapping the risk levels and the likelihood of genetic defects occurring, hence placing the care provider and the parents at a vantage point in terms of considering further diagnostic approaches as well as actions. On the other hand, as part of the subjective assessment, it is important to ask Nancy questions regarding her experience (medical) with the past pregnancies. This information is vital in predicting the progress of the pregnancy as well as understanding factors to expect during the course of her pregnancy. Information related to Nancy’s lifestyle is equally important as part of the assessment questions for this mother, it would be appropriate to ask questions related to the current use of medications and any other substance, say, smoking or drug/substance abuse. The integrity of a pregnancy and hence the well-being of the unborn relies of a various lifestyle aspects and medication history (London et al., 2015). For instance, there are classes of drugs that can terminate pregnancy or lead to complications. Knowledge of Nancy’s history with regard to the use of these medications or drugs can help in proactively addressing the accompanying risks.
During the first trimester, it is when most chromosomal defects occur and as an objective measure of assessment, it is important to consider several screening approaches. An ultrasound test (Nuchal translucency screening) can go a long way in checking the back of fetal neck for thickening. On the other hand, maternal serum tests for diagnosing the possibility of chromosomal defects are of utmost importance during the first weeks of pregnancy and the entire first trimester. These serum tests include; PAPP-A (pregnancy associated plasma protein) tests and the Hcg (human chorionic gonadotropin) (Davidson, London & Ladewig, 2015). The PAPP-A test helps in understanding the proteins produced by the placenta during the initial weeks of pregnancy, whereby abnormal values are associated with the likelihood of developing chromosomal defects (Davidson, London & Ladewig, 2015). Equally, the hCG tests sought to determine the level of production of the hormone by the placenta, whereby abnormal levels are associated with the risk of developing chromosomal defects (Davidson, London & Ladewig, 2015).
Although the AFP (Alpha-fetoprotein screening) screening is recommended for the second trimester, in this very case, it is important to consider this test since it helps in mapping the likelihood of various fetal defects (Davidson, London & Ladewig, 2015). Majority of fetal defects as afore-mentioned, occur during the first weeks of pregnancy, hence making it necessary to undertake these tests as a way of understanding the potential risks and pursuing proactive or preventive measures.
Getting pregnant after 35 years is associated with various risks which are unique from the recommended and healthy pregnancy age. Examples of the complications associated with pregnancy after 35 years as in the case of Nancy, include; increased risk for gestational diabetes, hypertension, low birth weights, miscarriage and chromosomal defects (London et al., 2015). This underscores the need for planning assessments in future to covers all these risk levels including regular assessment of blood sugar and blood pressure levels.
For this patient and couple, it is part of the care provider’s obligation to offer patient education on how to go about the management of the pregnancy in a bid to foster maternal and fetal health. Among the areas of education to consider include; diet management, physical activity, management of depression, desisting from pregnancy-unfriendly behaviors such as smoking and alcohol intake as well as the importance of regular screening (Davidson, London & Ladewig, 2015). Addressing all these knowledge areas helps in fostering the mother’s self-efficacy and self-care abilities which would ultimately lead to desired pregnancy outcomes, especially taking into account that Nancy’s age is advanced and nearing menopause.
References
Davidson, M. C., London, M. L., & Ladewig, P. W. (2015). Olds' maternal-newborn nursing & women's health across the lifespan. Prentice Hall.
London, M. L., Ladewig, P. W., Davidson, M. C., Ball, J. W., & Bindler, R. C. (2015). Maternal & child nursing care. Pearson Higher Ed.
