Management of High-Risk Pregnacy - Research Paper Example

Case Study Report: High-Risk Pregnancy al Affiliation Case Study Report: High-Risk Pregnancy The patient in this case study is a 39-year old mother of one young adult. She has however had eight other pregnancies that were coupled with problems and were either terminated electively or she miscarried. This is a comprehensive report of her pregnancy from at 17 weeks gestation. Referral Reason The patient is referred due to her pregnancy being high risk. First, she has a bad obstetric history, having lost seven of the previous pregnancies. She has conceived nine times and has only one surviving child. Further, it is also identifiable that the current pregnancy is coupled with a number of problems. First, she is overage. The risks of complications in pregnancy increase with age. Mrs. K is already past the safe age of 35 years. Secondly, she is obese. This complicates further her pregnancy due to the risks of conditions such as hypertension. In fact, she has already developed gestational diabetes and has to depend on insulin. It is also worth noting that her social history does not adequately support her health needs. This is clearly demonstrated by her inability to afford insulin, glucometer and glucometer strips. Besides, she cannot effectively maintain adequate bed-rest prescribed. Current Medical Status Currently, the patient is out of hospital. She has been monitored for 37 weeks at what time her cerclage is released and delivery conducted. She delivers a six-pound, two-ounce baby spontaneously without many problems. The puerperium is normal with the mother and child discharged home after only 48 hours after delivery in good condition. The management has successfully controlled not only the risk of pregnancy but also helped retain the mothers’ hobby, knitting. This assists the mother to save money on the baby’s blanket and also keep her busy and away from junk foods. Past Medical History The patient is diabetic and obese. She has to depend on insulin injections to control her blood sugars. She also has a bad obstetric history, having lost seven of her last pregnancies. She has only one surviving child, 18 years old. She has had cramping and false signs of pregnancy which could be the cause of previous loss of pregnancy. For this, she requires close monitoring in a high-risk obstetric clinic to ensure that this pregnancy matures to term. During the early third trimester, the patient was diagnosed with urinary tract infection and placed on antibiotics in consultation with the physician. Treating Physicians/Other Professionals This case was handled by qualified community obstetrician. The case manager was able to identify and handle all the client’s health problems throughout the period of pregnancy. Through active follow-up and collaboration with other professionals, the case was well managed. The other professionals involved in the case are the social workers, community health nurses, medical doctors, and special plans administrators for diabetic patients. Medications Throughout the case, the patient was on several kinds of medication. First, she was on diabetic control therapy involving the injection of synthetic insulin. This was aimed at controlling the blood sugar to ensure that this did not interfere with the pregnancy. In the late second trimester, the patient was put on antibiotics as medication to cure and control urinary tract infection after diagnosis. Socio/Environmental Socially, the patient appears to have a number of problems. First, she lives with a fiancé who has not been supportive enough in this pregnancy. The fiancé could be frustrated by the claimant lack of children and the poor obstetric history. She, however, has adequate support from the social workers who are rather responsive and supportive. They organize for her transport when the fiancé’s license is suspended and also collaborate with the case manager in monitoring the patient’s health. The environment she lives in supports health and only a little manipulation is required to ensure healthy living. Financial Insurance The claimant is not on any active financial insurance. She depends on the case manager’s interventions to reduce the cost of hospitalization and management. Through this case management, the claimant is able to save an approximate of $157,000 in a single pregnancy. Case Management Intervention The case manager uses several intervention strategies. First, the manager collaborates with other professionals in seeking help for the claimant. This is observed through the provision of glucometer and its strips from the plan administrators. Secondly, the case manager uses the help medical doctor severally; first to provide for diabetes monitoring, and second in the treatment of urinary tract infection. Further, the case manager is able to organize claimant’s transport to the clinic with the help of the social workers and to help in case follow-up with the nurses. In the control of obesity and diabetes, the case manager helps the claimant to get back to her knitting hobby and thus prevent binge eating. This also helps the claimant to do something constructive with her time, knit a baby’s blanket. Problems Identified This case highlights several problems. First there is the issue of birth control and health literacy. Conception beyond the age of 35 is risky for the mother and the child. It is often coupled with complications. Besides, the mother should have had adequate health education on weight control and diabetes control. Secondly, familial support is significantly lacking. The mention of a spouse, in this case, is only when he is unable to take the claimant to clinic. In the case study itself, the case manager identified problems related to diabetes in pregnancy, obesity in pregnancy, urinary tract infection, signs of premature labor and fluid retention. Case Management Recommendations It is recommended that active follow-up of clients should be done. Many of the problems are only identifiable with active and early intervention. Inquiry into the life and obstetric history of the claimant helps to identify possible risks and come out with workable interventions. The follow-up should also be collaborative, involving more than one type of health professionals. This puts the case manager at an advocacy position in the management of the patient. Estimated Hours for Case Management Assuming that, each of the interventions took two visits and that each visit took a duration of two hours. The case management I estimated to have taken a total of 24 hours. (6 interventions = 12 visits = 24 hours). Read More