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Question: 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.

21 Oct 2022,12:07 AM

 

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 woman/family?

Would you prescribe an antidepressant, and which one? What are possible adverse reactions to placing a woman on antidepressants in the post-partum 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 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.

Expert answer

 

What would be your initial approach to assessment and diagnosis with this woman/family?

The initial approach to assessment and diagnosis with this woman/family would be to perform a psychiatric evaluation. This would allow for a more in-depth look at the woman's mental state, as well as any potential comorbidities. It would also allow for an assessment of the husband's role in providing support to the woman. After the evaluation, a diagnosis can be made and an appropriate treatment plan can be implemented.

 

The woman's previous trauma and addiction history will likely play a role in her current mental state. It is important to address these issues with her in order to help her cope with her anxiety and depression. She may benefit from individual counseling and/or group therapy. Additionally, she may need to continue taking buprenorphine throughout her pregnancy in order to prevent withdrawal symptoms. The antidepressant medication may also need to be adjusted or increased in dosage in order to achieve desired effect.

 

It is important to involve the husband in the woman's treatment as he can provide support and understanding. He may also need counseling in order to deal with his own feelings about the woman's mental state and previous trauma. Ultimately, the goal of treatment is to help the woman cope with her anxiety and depression in a healthy way so that she can have a successful pregnancy and delivery.

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