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OB Case Study

OB Case Study Chapter 1
1 (a) Discuss how the cultural traits observed by Cherokee and her baby are specific to her
Native American culture
The Native American culture believes that women in labor should bear the pain of delivery at
any cost. Therefore, they will not accept pain management of any sort.
Colostrum is seen as dirty and therefore unsafe for the newborn.
They also believe that pain and disease is caused by evil spirits.
1 (b). Describe how the nurse would provide culturally sensitive nursing care to Cherokee and
her baby
The nurse will have to use education as a tool to help Cherokee understand the processes
employed in her care. Native Americans culture give more importance to mother, meaning it is
matrilineal. The Nurse first have to respect and understand the cultural influences and explain
that labor and delivery is not a punishment and that the pain does not have to be bared and
how medications would help to make this very important moment easier.
Understanding the levels of pain will also help the nurse to help with pain management since
culturally pain is not expressed verbally. The use of educational tools and the involvement of
other family members may help the patient to see the value of colostrum and the taking
medications and understanding breastfeeding. The discarding of the umbilical cord and
placenta must be discussed with patient. Health education is current practice in allopathic
medicine and nursing care is important to gain patient understanding and cooperation.
It is very important that the nurse does not argue or force the patient because this will cause
distrust and poor quality of care.
2. Discuss the educational requirements and scope of practice of a CNM
2 (a) A certified nurse midwife has post graduate training in the care of normal pregnancy and
childbirth and is certified by the American college of Nurse midwife. They are educated in two
disciplines nursing and midwifery and pass a national certification exam administered by the
American Midwifery Certification Board (AMCB)
It encompasses a full range of primary health care services, including the independent provision
of primary care, gynecologic and family planning services, preconception care, care during
pregnancy, childbirth and the post-partum period, care of the normal newborn during the first
28 days of life and treatment of male partners for sexually transmitted disease. Mid wife
provides initial and ongoing comprehensive assessment diagnosis and treatment.
They conduct physical exams , prescribe medications including controlled substances and
contraceptives methods. They also admit, manage and discharge patients, order and interpret
lab and diagnostic tests and order the use of medical devices. Midwifery care includes health
promotion, disease prevention and individualized wellness education and counseling. These
services are provided in various settings including ambulatory settings, private offices,
community and public health systems, homes and hospitals and birth centers.
2 (b). Under what condition should Kelly receive care under the OBGYN?
If Kelly presents with any complications of pregnancy, she should be treated by the OBGYN,
because the scope of practice for the CNM is to care for normal uncomplicated pregnancies.
2 (c). Why do you think her mother views midwifery care as “settling”?
Her mom does not understand the educational background and training of the CNM. She also is
unaware of the scope of practice of the midwife and clearly equates the lack of insurance with
whatever she views the provision of care of the midwife to be.
OB Case Study Chapter 2
1(a) As a community-based nurse, what considerations are important in the care of Maria and
the baby?
Being familiar with different cultures is a very important aspect of community nursing. Because
the family ha only been in the USA 8 months, the nurse needs to understand they are still
adapting to culture and language differences. There is also the additional stress of other family
members in the home and therefore other needs to take care of.
Maria plans to go back to work after 12 weeks leaving a premature baby is not ideal, therefore
she needs to be educated on how to care for an immature baby and about the resources and
support systems available to support the family with care.
1(b) Using the three levels of prevention in the community-based nursing, what can you teach
Maria care and infant care?
Primary prevention the prevention of disease before it occurs
Secondary prevention is the early detection and treatment of and adverse health condition
Tertiary Prevention is designed to reduce or limit the progression of a permanent or irreversible
It is vital the community-based nurse teach Maria about the importance of self-care, good
hygiene, proper diet, and exercise to help prevent post-partum complications. Also, she needs
to be educated about immunization regime.
2 (a). As the registered nurse, what assessments do you need to make in regard to this infant?
I would a complete physical assessment, obtain vital signs, and location and intensity of rash.
2 (b). Realizing that complimentary and alternative therapies are frequently utilized by women
in the in eastern Kentucky how should the nurse approach the topic of feeding a 2-month-old
breast fed baby “catnip tea”?
In a private setting I would use open ended questions to determine why she was giving the
baby “catnip tea”. I would then use the opportunity to educate her on the importance of
feeding only breast milk at this time.
2 (c). What underling principles does the nurse need to remember in regard to communitybased care and CAM therapies and/or treatments?
The respect and the stimulation of stimuli with regards to adaption of the belief and the
attitudes of the patient. The nurse should be sensitive to this and should take this as a
consideration. A measure of sensitivity and should be practiced by the nurse.
2 (d). Utilizing an interdisciplinary health care team approach, how might the members of the
team proceed with health teaching with Sarah regarding the “catnip tea” and
overdressing/overheating of Daniel
The nurse needs to develop a trusting relationship with Sarah. This will help her with the
cooperation need by the health team. Using proper communication skills and open-ended
questions will provide information on how to properly dress the baby.