Uploaded by seabeewife40

careplan 121221

Turner Syndrome; Care Plan
Katie Bernath
Rasmussen University
Professor Turner
December 10, 2021
Care Plan: Turner Syndrome
Turner Syndrome is a condition that only occurs in females. It happens when there is a
complete absence or partial absence of an X chromosome, resulting in a 45, X karyotype (Beery
et al., 2018). Turner Syndrome causes genetic alterations within the client (Mayo Clinic Staff,
2017). This is the most common chromosomal abnormalities, and 99% of fetuses do not survive
and spontaneous abort in the first trimester. There are 1 in 2,500 female infants born with Turner
Syndrome each year. Diagnosis typically occurs at birth or during pregnancy because of the
phenotypic features presented (Beery et al., 2018).
Genetic and Genomic Assessment Findings
With the lack or partial lack of a X chromosome, the classic phenotypic features include
neck webbing, smaller than average at full term birth, cardiac abnormalities, and pedal edema
(Beery et al., 2018). At birth, infant girls with Turner Syndrome may have Lymphedema which
is swollen hands and feet. Infants can also have sausage-like fingers and toes due to a
combination of lymphedema and dysplastic or hypoplastic nails. The client may have dental
issues such as arched palate, malocclusion, or dental crowding. Other characteristics include
loose folds of skin called cutis laxa, a shield chest, short stature, and ovarian failure (Belleza,
2021). After diagnosis a full blood panel including screening for LH and FSH should be done
regularly since long term complications can include an autoimmune disorder like
hypothyroidism (Mayo Clinic Staff, 2017). Additional tests should be done such as:
Echocardiography or MRI of the heart and aorta, hearing tests, glucose metabolism and renal
collecting system for abnormalities (Belleza, 2021).
Genetic Testing
Prenatal tests such as a cell-free DNA screening or fetal ultrasound can detect physical
abnormalities such as heart defects, nuchal cystic hygroma (fluid filled cavity), or abnormal
kidneysthat show signs of Turner Syndrome (Mayo Clinic Staff, 2017). Karyotyping which
looks for the presence of a 45 X cell or the shortened leg of an X chromosome is a standard
maternal blood test that can also be done during pregnancy or after delivery to diagnose Turner
Syndrome. Additional testing prior to birth that can be done to test for Turner Syndrome is
obtaining a small sample of amniotic fluid called an Amniocentesis. Another test that involves
removing a small piece of tissue from the placenta called Chorionic Villus Sampling is another
diagnostic test that can diagnose Turner Syndrome (Mayo Clinic Staff, 2017).
Ethical Dilemma & Considerations
Since Turner Syndrome can be diagnosed during the prenatal stage, this leaves the family
with an ethical dilemma that the mother and father may choose to decide to terminate the
pregnancy. Abortion is a controversial subject that is complicated when it comes to the
components or quality of life of an unborn infant and the choices of a woman. If the parents find
out ahead of time that their child has a high possibility of having Turner Syndrome, they must
make the difficult decision to keep or terminate the pregnancy. There are many challenges that
a family must face with a child that has Turner Syndrome. Some challenges could be worried
about financial stressors and the possible struggles for their child in the future. One reason the
parents might choose to abort is due to the reasons that woman with Turner syndrome will not be
able to have biological children, have plenty of medical issues, and might not have the best life.
The child will grow up and have her own ethical consideration of when and how to tell her
partner about her fertility issues (Clark, 2015). A reason that the mother or another family
member might not want to abort is the belief that the unborn infant is still a human life and even
though they will have many medical conditions they can still live a fulfilled life. While there are
these ethical considerations, there are many more involved with medical treatments such as using
Growth Hormone therapy used for young girls that have Turner Syndrome (Wasserman & Asch,
Ethical theoretical foundations for genetic testing is to make sure the client receives the
best possible care and treatment with respect when it comes their choice of treatment. It is
important to use Ethical theoretical foundations when creating a care plan for a client. Provision
1 of the ANA Code of Ethics says to treat patients with compassion, respect their dignity, worth,
and unique attributes (ANA code of ethics, n.d.). An individualized care plan is so important
when considering the client’s needs. Provision 2, 3, and 4 must also be considered whencreating
the care plan. The ANA Code of Ethics Provisions 2, 3, and 4, says, “The nurse’s primary
commitment is to the patient. The nurse promotes, advocates for, and protects the rights, health,
and safety of the patient and takes action consistent with the obligation to promote health and to
provide optimal care (ANA code of ethics, n.d.). Sadly, some medical professionalswill have a
biased opinion and will give the client advice instead of giving the client all the options that is
available to them. A nurse must remain unbiased and always put their clients’ needs first as long
as the client is competent to make those decisions. It is the nurse’s responsibility to provide the
proper care and treatment for their client and follow the ANA’s Code of Ethics.
-Patient has
-Experience low
history of Turner self-esteem
/depression due
to body
-Patient has
symptoms of:
-Pedal edema.
-Lymphedema is
hand and feet.
-Short stature
less than typical
for age.
-Patient has
feminine issues
with her period
or infertility.
-Patient has
Dental issues
-Neck Webbing
(Belleza, 2021)
nutrition: due to
more than body
requirements as
(Belleza, 2021)
Goals/Expected Interventions
-Patient will
identify feeling of
perception of self.
Patient will
behaviors to
restore positive
-Improve selfesteem. Help
patient identify
feelings and
express them in
a healthy way.
- Improve
physical health.
-Patient will learn
to make healthy
food choices by
(walking, bike
going through food riding).
-Patient will
(Belleza, 2021)
maintain food
-Patient will eat 6
with Dietician
small meals
to determine
throughout the day patient’s caloric
-Patient will
participate in at
-Plan activities
least 30 minutes of to discuss food
physical activity
groups and their
serving size.
patient’s weight
(Belleza, 2021)
and appetite
(Fruh, 2017)
patient to
consume foods
low in
calories, and
saturated fats.
(Fruh, 2017)
therapy is
prescribed by
physicians to
stop stature
Goals are met
by patient’s
of positive
behaviors to
help restore
Patient also
participated in
regimen with
and taking
(NIH, 2016)
-Patient is
referred to
(dietician and
-Patient met
goals by
meeting with
(Belleza, 2021) Dietician and
dietetic plans.
learned how
to make
healthy food
named food
groups, and
participated in
activity for 30
minutes’ daily
(Fruh, 2017)
Intraprofesional and Interprofession Strategies
-For Intraprofessional Strategies: The Primary Care Team will be responsible for
diagnosis, monitoring symptoms, and referring patient to other specialties.
-For Interprofession Strategies:Referral to Cardiology for EKG, MRI of heart and
aorta, evaluate 4 limb blood pressure. Referral to Endocrinology for Glucose metabolism,
screening for diabetes mellitus and Thyroid function tests. Referral to Obstetrics and
Gynecology for Growth hormone therapy. Nephology for Renal studies. Therapy for mental
health and body issues. Dietician for food intake and management (Belleza, 2021).
Care Plan/Conclusion
The goal of the care plan is to support the client through any physical and/or mental
challenge. Females are affected with Turner Syndrome due to alteration of one of the X
Chromosomes. Individuals with Turner’s Syndrome may experience health problems, low selfesteem, and/or body issues. The nurse and other health care providers must work together to
ensure their client is receiving the best quality care that can be provided. The nurse can help by
identifying feelings and encouraging the client by providing additional resources. The one thing
should remain constant though the entire process is the ethical obligations. This includes justice,
autonomy, and beneficence. These obligations if upheld will help healthcare providers
collaborate and reduce issues making the patient experience better and usually live a good
fulfilled life.
ANA code of ethics. (n.d.). https://www.vcuhealth.org/explore-vcu-health/for-heatlhprofessionals/nursing/about-nursing-at-vcu/ana-code-of-ethics.
Beery, T.A., Workman, L.M., Eggert, J. (2018). Genetics and genomics in nursing and
health care (2nd ed.). F.A. Davis. https://ambassadored.vitalsource.com/#books/9780803676824.
Belleza, M. (2021, February 11). Turner Syndrome Nursing Care Management.
Nurselabs. https://nurselabs.com/turner-syndrome/#further_reading.
Clark, A.A. (2015). Turner Syndrome: Addressing how misconceptions overshadow
opportunities for a “normal” life. https://www.counseling.org/docs/default.
Fruh S.M. (2017). Obesity. Journal of the American Association of Nurse Practitioners,
29(S1), S3-S14. https://doi.org/10.1002/2327-6924.12510.
Mayo Clinic Staff (2017). Turner Syndrome: Symptoms and Causes. Accessed
December 10, 2021. https://www.mayoclinic.org/diseases-conditions/turnersyndrome/symptoms-causes/syc-20360782.
NIH. (2016). Turner Syndrome Genetic and Rare Diseases Information Center (GARD) –
an NCATS Program. https://raredieseases.info.nih.gov/diseases/7831/turner-syndrome.
Wasserman, D., & Asch, A. (2012). Reproductive medicine and Turner syndrome:
Ethical issues. Fertility and Sterility, 98(4), 792-796