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    Perinatal Nursing: Day 2 online discussion

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    railibo-
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    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:17 pm

    the infant has increased risk of developing hepatitis..

    Angel Ve
    Guest

    Answer 2

    Post  Angel Ve on Tue 11 Aug 2009, 9:09 pm

    im sory classmates. what I was trying say was moving on to the next case.

    Case Study on Hepatitis B in a Pregnant Woman

    A woman in labor presented to a suburban birthing hospital. The hospital staff found that she has not been tested for HbsAg this pregnancy because her family practice physician said she was negative two years ago so not to worry about it. The hospital correctly ordered a test, but did not ask the test to be done as quickly as possible and did not give the infant hepatitis B vaccine dose #1 within 12 hours of birth. The infant was discharged two days after birth; the mothers HbsAg test came back positive three days after birth. That same day, public health representatives tracked down the family and made sure the infant immediately received vaccine dose #1 and HBIG. Hepatitis vaccine doses #2 and #3 were given accordingly to the recommended schedule

    Questions for discussion:

    1. What risk/s does an infant born to a mother positive for HBsAg have?
    2. In the case, the mother was not immediately tested fro HBaAg. Ideally, when should pregnant women be tested for HBsAg?
    3. What is the correct medical management for this woman, having known that she was positive for HBsAg?
    What is a possible adverse effect of treatment on the fetus? What happens to the baby if the vaccine is
    not received on time?

    4. What are important considerations in handling and administration of hepatitis B vaccines.

    5. Upon knowing that a mother is positive for HBsAg, how will you care for her during the intrapartal period?

    6. What is the preferred method of delivery in pregnant women found positive for HBsAg? Why?

    7. Should breastfeeding be encouraged?

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:08 pm

    Augh...women are really in for some tough fight for their lives during their pregnancy...

    Angel Ve
    Guest

    Answer 2

    Post  Angel Ve on Tue 11 Aug 2009, 9:06 pm

    yes ara, but then the assessment done to Jyotsana was not mention whether its comprehensive or not.. Can we now move on to the next question?

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:06 pm

    agree! it's really frustrating. Especially of the idea that she could have lived if they only knew what to.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for the DOCTOR..

    Post  ara_portillo on Tue 11 Aug 2009, 9:06 pm

    well... for what the doctor could have done.. i've mentioned them to my previous posts.. like proper assessment, initial management prior to referral should have been done. also, he should have informed the family well about the condition..

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:04 pm

    rai, this only implies that problems on pregnancy happens at all women of different walks of life. sad and depressing, but death chooses no one.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for tina..

    Post  ara_portillo on Tue 11 Aug 2009, 9:03 pm

    yes tina.. it could imply that the prenatal check-ups in that place - which purpose supposedly is to assure safe and healthy pregnancy is quite poor in terms of the assessments done..

    Angel Ve
    Guest

    Answer 2

    Post  Angel Ve on Tue 11 Aug 2009, 9:02 pm

    I think we are all looking into the knowledge and skills of the doctor in determining the problems with Jyotsanas pregnancy. If only he was able to refer Jyotsana, death will not occur. It is also good that Ara and Tina considered the family as a factor wherein they were not able to do the right decision.

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 9:02 pm

    yup i agree with ara, besides she has enough financial resources. Coming from a well to do family ,then it only means that getting good health care services is not impossible for her. Unlike the case of Amparali and Lata.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 9:00 pm

    ara, agree.that was what i am trying to point out, at the level of jyotsana's prenatal care, was it enough and even complete and comprehensive? if it was then subtle signs should have been observed/depicted in the whole process of prenatal care.

    the patient is on her eight month, one month to go and the patient id off for delivery. so frustrating and sad that the patient died.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for thea.

    Post  ara_portillo on Tue 11 Aug 2009, 8:59 pm

    yes thea.. that is what i meant by the proper prenatal education that should have been given to her.. part of it are the ways on assessing the well being of the fetus like the "fetal kicks".. and others..

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 8:59 pm

    The family or even jyotsana could have asked the doctor of her true condition, subjecting themselves to be assessed by doctor gave them the right to know the REAL result. They should have also asked any alternative treatment since her chief complaint was abdominal pain and fever.

    As for the doctors, they could have done something better and could have save the life of Jyotsana or even her baby. They could have informed them what is really happening. They could have also assessed her properly.Lack of skilled health workers assigned to different rural areas is still main problem of health sectors of different countries.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    what could have been done differently...

    Post  ara_portillo on Tue 11 Aug 2009, 8:55 pm

    The information given in the case is somewhat limited to judge the quality and frequency of Jyotsana's prenatal visit. If she is having her prenatal check-up with the same private doctor, well possibly, her real condition will not really be monitored. If she is also given a good prenatal check-up, proper health education about the dangers in pregnancy should have been communicated to her..

    For the family, and for Jyotsana also, while waiting for the decision of the doctor, they should have been more assertive with their need to be informed with her/Jyotsana's condition.. or if nothing is being done to Jyotsana, they should have decided early to transfer her to another treatment facility...

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 8:52 pm

    Nothing (I think) should she have done differently, because she was attending her check-up routinely. I believe that she had been faithfully doing what is recommended of her. Although being a mother, youll be able to know or even feel if the bay is still alive in your womb. It was not clear, if the health care providers even instructed her on ways to check for the well being of the fetus. So it remains a big question.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 8:52 pm

    for the subsequent questions: WHAT could have been done differently.

    well, there are a lot of actions that should have been done in this particular case. first, given that the patient was 20 yo and her first pregnancy, then the family must have consulted the doctor in the district hospital. and also upon the problem, the family and the patient herself must have wondered what is really the problem to the patient and thus must seek for medical care in other institutions.

    for the doctors, the doctor must have paid attention, assessed properly or to the very least, refer the patient if it was his/her conviction that he can't diagnose the patient himself/herself. The doctor must have considered that factors that jyotsana is only 20 yo and it was her pregnancy and it was only her eight month and so fever and abdomen pain are indeed indications that there is a problem.

    also, prenatal check up system in small villages must be reviewed and modified to the point that at this level, any problem that may affect the pregnancy of any patient will be detected so that delays will be prevented and prompt management will be provided.

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 8:50 pm

    rai, i think 20 is not yet safe to be pregnant...at least 23-24 y/o ...i am not sure...will look for literatures about that...

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 8:49 pm

    I agree with thea...about the doctor not doing his/her job well of assessing the patient. on the other hand I think Jyotsana should have asserted her right as a patient to know everything about her condition..or better yet if she's not satisfied with the service done to her, then she should have made the initiative to look for another doctor and have herself be assessed again.

    Angel Ve
    Guest

    Answer 1

    Post  Angel Ve on Tue 11 Aug 2009, 8:46 pm

    okay girls.. i think we all agreed on the underlying causes for Jyotsana'a death. (age, pregnancy being uneventful and it was her first pregnancy, the doctor who is not competent enough to diagnose the disease, inaccessibility of the health facility and delay in the decision making)
    Let us now answer the next question..

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Perinatal Nursing: Day 2 online discussion

    Post  Althea Perez on Tue 11 Aug 2009, 8:45 pm

    it was stated in the case that the doctor didn't assess Jyotsana well. Since the doctor did not assess her well, he can't come up with a diagnosis. Afraid of giving a wrong diagnosis could be a factor as well.

    railibo-
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  railibo- on Tue 11 Aug 2009, 8:45 pm

    yup i agree...but angel, i thought female who are 20 years old are considered to have a mature reproductive system compared to those who are below 20..

    arch_ang
    Guest

    Re: Perinatal Nursing: Day 2 online discussion

    Post  arch_ang on Tue 11 Aug 2009, 8:44 pm

    i agree about the age...

    even if the doctor is busy, i think, he/she must inform the family...or at least refer for hospital admission if the doctor is not sure about the dx..

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    other causes..

    Post  ara_portillo on Tue 11 Aug 2009, 8:42 pm

    yes.. there are other causes.. the pregnancy at a young age (Jyotsana is 20 y/o) and the pregnancy being uneventful...

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Perinatal Nursing: Day 2 online discussion

    Post  ma. cristina arroyo on Tue 11 Aug 2009, 8:40 pm

    internal factors could be first age, jyotsana was only 20 years old. second, it was her FIRST pregnancy. those two classified her as a high-risk pregnancy.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    the doctor..

    Post  ara_portillo on Tue 11 Aug 2009, 8:39 pm

    well possible reasons why the doctor did not tell anything to the family will be:
    1) he is not sure with the real diagnosis (I doubt but maybe such cases really happens)
    2) poor assessment skills done, associating the condition with a simple premature contractions...
    3) the doctor is too busy (???)
    4) he thinks he can handle the case..

    But whatever the reason is, i think the doctor have violated the right of the family to the full disclosure of information regarding the worsening condition of Jyotsana..


    Last edited by ara_portillo on Tue 11 Aug 2009, 8:41 pm; edited 1 time in total

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