Issues in Advanced Nursing Practice: Unfolding Case Study of a 55-Year-Old Female

Summary of the chosen case study: The case study is about a 55-year-old female, Gloria Smart, who comes to the office for regular gynecological care. She has a cardiac stent, mild hypertension, and is on Zocor, Plavix, and lisinopril. Gloria wants a referral and guidance on having a child with her fiancé. The case study proceeds with Gloria’s preconceptual recommendations, followed by her consultation with a maternal-fetal medicine specialist and an infertility specialist. She gets pregnant with donor egg and is referred back to the nurse at 12 weeks to be co-managed with the maternal-fetal medicine specialist. Later, Gloria complains of high blood pressure and is diagnosed with preeclampsia, leading to an abrupt delivery of a male infant who lived for 20 minutes.
Differential Diagnosis: The differential diagnosis for Gloria Smart includes hypertension, cardiovascular disease, and preeclampsia.
Diagnosis decision: The diagnosis decision is made based on Gloria’s medical history, her symptoms, and her physical examination. Her diagnosis of hypertension and cardiovascular disease is confirmed by her medical history and her elevated blood pressure levels. Her diagnosis of preeclampsia is confirmed by her physical examination, where she has 2 pitting edema in her legs and her face appears slightly swollen.
Treatment plan: Gloria’s treatment plan includes preconceptual folic acid supplementation, a change in blood pressure medication, discontinuation of cholesterol medication and Plavix, and starting a baby aspirin daily. Gloria is also advised to discuss the risks of alcohol and pregnancy. When Gloria’s blood pressure is high, she is started on IV magnesium sulfate and given several doses of IV labetalol to control her blood pressure.
Evidence-based research: Evidence-based research supports the diagnosis and treatment of hypertension and preeclampsia. Studies have shown that preconceptual folic acid supplementation reduces the risk of neural tube defects. Research has also shown that magnesium sulfate and labetalol are effective in controlling hypertension in pregnancy and reducing the risk of complications such as placental abruption.
Resources used: Best practice guidelines were followed in diagnosing and treating Gloria’s medical conditions. The nurse used medical textbooks, research articles, and online resources to ensure that she provided the best care possible to Gloria.
Ethical, psychological, physical, and financial issues: The case study presents several ethical, psychological, physical, and financial issues. The nurse must consider the ethical implications of providing care to a patient who wants to have a child despite having a significant cardiac history and being on category x drugs. The nurse must also be sensitive to Gloria’s psychological needs and provide her with emotional support during her pregnancy. The nurse must monitor Gloria’s physical condition and ensure that she receives appropriate medical care to manage her hypertension and preeclampsia. Finally, the nurse must consider the financial implications of Gloria’s medical care and ensure that she receives appropriate insurance coverage and financial support to manage her medical conditions.

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