complicated pregnancy

Week 3 Assignment 1: Complicated Pregnancy

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3. NU-665C-06-23PCFA
4. Week 3: Psychiatric Care in the Reproductive Years
5. Week 3 Assignment 1: Complicated Pregnancy

Completion requirements

To do: Make a submission

Due: Sunday, 17 September 2023, 11:55 PM

Value: 100 points

Due: Day 7

Grading Category: Assignments

Instructions

For this assignment, you will complete the Complicated Pregnancy Interactive. You will need a minimum of two scholarly references to support your work, one of which should be from a nursing journal.

Please refer to the Grading Rubric before starting your case.

• This activity will walk you through a patient scenario and have prompts for you to answer along the way. The activity will save your answers, which will allow you to print them out at the end of the activity to submit to this assignment.
• Follow the requirements posted in the rubric.
• Your answers should be thorough and match the complexity of the scenario. Provide resources to support your answers.
• When you have completed the activity, please save as a PDF of your answers and upload the printout to this assignment for grading.

Please refer to the Grading Rubric for details on how this activity will be graded.  

These are the questions

Complicated Pregnancy Case Study

1.Jamie enters your office today as a new patient seeking a psychiatric evaluation and possible medication management. Jamie is a 37-year-old white, cis-gendered, married woman who is currently 8 weeks pregnant. Her husband, a pharmacist, is present for the session today as well. As you work through the psychiatric interview, you learn that Jamie is currently prescribed a prenatal vitamin and buprenorphine/naloxone 8mg/2mg once daily.

What next Questions do you have for Jamie?

2.You learn that Jamie experienced a pelvic fracture during her first delivery which caused excruciating pain. She was prescribed opioid pain medication following the fracture, but she found that she needed the medication for longer than her physicians felt appropriate. She found it increasingly difficult to taper and/or stop taking the opioid medications, so she started purchasing opioid medications illicitly. You learn that after about 3-6 months of illicitly using opioids, her husband learned about her medication misuse and encouraged she enter treatment. Following a discussion with husband, who has remained supportive throughout, she went to an outpatient substance use disorder clinic and was placed on the buprenorphine/naloxone.

As a PMHNP, what education would you provide Jamie about buprenorphine/naloxone use in pregnancy?

3.You know that best practices encourage continued opioid maintenance treatments throughout pregnancy to prevent relapse, which would be more harmful to Jamie and the fetus. As the interview progresses, Jamie becomes tearful as she describes her fears surrounding giving birth again. She is plagued by the memories of the first birth which resulted in the pelvic fracture. She reports she has noticed increased anxiety since learning she is pregnant. Although she states she is genuinely happy to have a second baby, she feels she cannot enjoy her pregnancy due to her worries that her pain will not be controlled during and after delivery and that her baby will be born addicted to opioids. She often finds herself ruminating on the events from the first delivery.

What education can you provide to Jamie regarding her concerns?       

4.You move past the substance use disorder portion of your interview and focus on Jamie’s current psychiatric symptoms and their possible etiologies.

What screening tools would be appropriate to use with Jamie?

5. You find that Jamie’s GAD-7 score is 18, her PCL-5 score is a 32 and her PHQ-9 is a 6.

Given the information you currently have on Jamie, what other questions would you ask her regarding her current symptoms?

6. List 3-5 differential diagnoses for Jamie.

7. Of your differentials, which diagnoses would you, the PMHNP, choose as a primary diagnosis to work on for today’s session?   

8. Describe your pharmacologic treatment regimen below, including medication chosen (if any) and why; risks, benefits, side effects and alternatives as well as relationship to trimester should also be included

9. What patient education will you provide regarding your chosen medication?  

10. What non-pharmacologic treatment options would you suggest for Jamie?  

11. Jamie returns to see you when she is 20 weeks pregnant. She reports improvements in her anxiety and overall functioning. She asks about her current medication regimen and its impact on her unborn baby once she enters the third trimester. She also asks about safety of her current medication regimen in breastfeeding and postpartum in general.

What education do you provide to her?

12. What will be your safety plan and follow up plan for Jamie?

13 Please enter any additional information you would like to include on this case.

You will need a minimum of two scholarly references to support your work, one of which should be from a nursing journal.

Jamie is pregnant and experienced trauma during the birth of her first baby. She  was taking opiods and misusing them. Now prescribed and is taking buprenorphine.

As a PMHNP, what education would you provide Jamie about buprenorphine/naloxone use in pregnancy?

What education can you provide to Jamie regarding her concerns of the effects of this medication on her baby?

Jamie is stressing, anxious and depressed about giving birth to her 2nd child, due to the previous pelvic fracture during the first birth, but wants to give birth w/o complications. What screening tools would be appropriate to use with Jamie PTSD, ANXIETY and Depression?

List 3-5 differential diagnoses for Jamie and why? Discuss DSM-5 rationale

PTSD F43.10 MDD, single episode F32.0 Generalized Anxiety F41.1

Of your differentials, which diagnoses would you, the PMHNP, choose as a primary diagnosis to work on for today’s session?

I would choose PTSD related to the past trauma during the birth of her first child.(elaborate)

Describe your pharmacologic treatment regimen below, including medication chosen (if any) and why; risks, benefits, side effects and alternatives as well as relationship to trimester should also be included.

I would choose a SSRI such as Prozac. (elaborate)

What patient education will you provide regarding your chosen medication? (Prozac use in pregnancy)

What non-pharmacologic treatment options would you suggest for Jamie?

What education do you provide to her? Regarding taking Prozac at 20weeks of pregnancy and breastfeeding

What will be your safety plan and follow up plan for Jamie?

Conclusion: Please enter any additional information regarding a PMHNP caring for a complicated pregnant patient.

Complicated Pregnancy

Instructions

You are caring for a 37-year-old woman who is pregnant with her second child. Her first pregnancy was traumatic as she experienced a pelvic fracture during delivery causing excruciating pain. Also, during this time she became addicted to opioids and has continued on buprenorphine during this second pregnancy. The anxiety from these memories plagues her. She is fearful that she will not be given adequate pain medication during the birth and that the baby may experience withdrawal symptoms. She has been prescribed an antidepressant for anxiety and depression. Her husband is a pharmacist and has attended most visits with the psychiatric-mental health NP for counseling and psychopharmaceutical drug management.

• What would be your initial approach to assessment and diagnosis with this patient and her family?
• Would you prescribe an antidepressant? If so, which one? What are possible adverse reactions to placing a woman on antidepressants in the postpartum phase?
• Explain the pharmacodynamics, pharmacokinetics, contraindications, pregnancy-related issues, legal/ethical considerations, testing (if applicable), side effects, and relationship to trimester.
• What would be your plan of care including the strengths and weaknesses of the family functioning and supporting attachment? (Be succinct.) Consider any supervision/collaboration/type of psychotherapy or complementary modality you might use.

Criteria for this paper:

• Answer these questions succinctly but completely, integrating resources to provide rationale for all decisions.
• Use APA formatting for all components of your paper.
• Your paper should be approximately three to four pages long and in APA format.
• Your paper length should not include the reference page.
• Use at least one nursing journal reference from CINAHL (available through the Regis library) to support your rationale.

(You can use or reference this article I got it from CINAHL 10.1016/j.ajog.2022.06.007)