UNIVERSITÉ DE SAINT-BONIFACE
School of Nursing and Health Studies - Preclinical/Simulation Preparation SINF 2037
Date: January 31st, 2025
Client Initials: N.M
Student: Samantha Hamelynck et Sana Kasem
Biological sex: Female
Age: 31
Marital Status: Unknown
Primary diagnosis (& surgical interventions
Secondary diagnosis or coexisting pathologies (medical hx, past
if applicable, labour history)
obstetrical hx/complications)

Decreased baby movements at 35
weeks pregnant. (Can indicate a
change in the baby's well-being
and may be a sign of underlying
issues)


-
Recurring spotting at 35 weeks pregnant.
Limited access to prenatal care.
-
Date of admission:
Discharge Plan:

Gravida : 6
Para : 5
Term : 5
Abortion : 0


Diagnostic tests (date, reason for test)
Mother :







Rh
Hep. B
Rubella (To confirm immunity)
HIV
Syphilis screening
Chlamydia
Gonorrhea
Results (& trends, interpretation)




Rh Factor = Positive (No risk for
isoimmunization)
Hepatitis B = Negative (No infection
detected)
Rubella = Immune (No risk for
congenital rubella)
HIV = Negative (No maternal to child
transmission risk)
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Nursing Implications
Today
Complete a
comprehensive
prenatal
assessment.
Complete a
non-stress test
(NST).
Provide
education to
the patient.



Blood group (Prepare for potential
blood transfusions during delivery
or due to bleeding)
Hemoglobin (Assess for anemia)
Platelets (Assess for clotting
abnormalities)






Syphilis = Negative (No infection
detected)
Chlamydia = Negative (No infection
detected)
Gonorrhea = Negative (No infection
detected)
Blood group = O
Hemoblobin = 105 @ 12 weeks
(Normal)
Platelets = 350 @ 12 weeks (Normal)
Allergies (& reaction) : No known allergies.
Medications (classification, dose, route)
Reason for Prescription (specific to patient)
Nursing Implications
Treatment in Progress (& consults; rationale for each)
Mother’s Health :




Admit to triage for assessment. (Decreased fetal movement at 35 weeks' gestation)
Vital Signs on admission. (Get a baseline and also to identify any maternal issues such as hypertension or infection)
Comprehensive prenatal assessment (Confirm fetal well-being and address maternal concerns)
Obtain weight (Monitoring weight gain/loss helps assess the nutritional status and fetal growth)
BABY’s Health :


Non-Stress Test (NST) : Notify Md of results (To monitor the baby’s heart rate, movement and oxygen levels)
Fetal Monitor
Psychological Needs

Sociocultural Needs/Social Supports
Offer reassurance, explain the monitoring process, and keep her
informed about the results to reduce her anxiety.
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
Ask Nadine questions about her relationship with
her partner and family to understand if they provide
emotional and practical support.



Being away from her family and community could cause distress :
Offer resources to support groups available in Winnipeg.
Validate Nadines feelings and encourage her to express concerns.
Address her worries about the baby’s health and provide consistent
updates on her condition.


Assess Nadines needs for transportation to and
from Winnipeg and her accommodation needs
while accessing care in the city.
Connect Nadine with Indigenous-centered
healthcare services to ensure culturally appropriate
care and support.
Informational/Teaching Needs :



Educate Nadine about warning signs to watch for such as regular contractions, severe abdominal/lumbar pain, increased vaginal
bleeding or decreased fetal movement and when to seek further care.
Provide information on the purpose and the results of the non-stress test.
Educate Nadine how to check daily for baby movements and she should feel at least 6 movements in 2 hours.
Material Resource Needs
-
Spiritual Needs
Vital sign machine.
Scale to take patient's weight.
Fetal Monitor.
Educational materials about prenatal care, signs of complications and
fetal movement tracking.

Ask about any spiritual or cultural practices Nadine
might want incorporated into her care, such as
smudging.
Specific Problems and Appropriate Care (PLAN)
Ineffective health maintenance r/t limited access to healthcare services and geographic isolation as evidence by lack of consistent
prenatal care :
Goals :
-
Nadine will verbalize an understanding of the importance of ongoing prenatal care.
Nadine will schedule a follow-up prenatal care appointment.
Interventions :
-
Develop a follow-up schedule with Nadine and her healthcare provider to ensure ongoing monitoring and care.
Educate Nadine about the importance of regular prenatal checkups, including fetal assessments.
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-
Provide Nadine with information about prenatal care services and support available in Winnipeg.
Collaborate with a social worker to assist Nadine in accessing transportation and accommodations for continued care.
Deficient knowledge r/t lack of prenatal education as evidence by lack of education on fetal movement tracking and warning signs :
Goals :
-
Nadine will verbalize an understanding of self-monitoring practices.
Nadine will verbalize an understanding of when to seek care.
Interventions :
-
Educate on the signs and symptoms requiring urgent care, such as heavy bleeding, severe pain, or persistent reduced fetal
movement.
Ask Nadine to explain what she knows about fetal movements, warning signs, and prenatal care.
Identify any cultural, language, or literacy barriers that may affect her understanding of prenatal care and education.
Offer tools like fetal movement tracking apps, charts, or calendars.
Show Nadine how to count fetal movements.
Educate Nadine she should feel at least 6 movements every 2 hours.
Anxiety r/t concerns about decreased fetal movement, separation from family/community, and limited access to prenatal care AEB
maternal verbalization of worry about the baby's health :
Goals :
-
Nadine will verbalize decreased anxiety.
Nadine will report an increased understanding and control regarding her pregnancy and baby’s health.
Nadine will demonstrate the ability to use relaxation techniques to manage anxiety.
Interventions :
-
Provide emotional support and regular updates on her and the baby’s condition.
Offer resources for Indigenous-centered support groups and healthcare services.
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-
Introduce relaxation techniques such as deep breathing.
Preparatory Questions:
1. To ensure a culturally safe practice and attitude, reflect on and answer the following:
• Who do you represent when introducing yourself to an Indigenous woman living on a remote reserve? :
Not only am I representing myself, but I am also representing Nurses, the university and the whole Health Care system.
• How might she feel about traveling to Winnipeg alone? :
She might feel lonely, anxious, or scared because she is away from her family and community. She may also fear discrimination or
mistrust due to past experiences with the health care system.
• Why might she be traveling alone? :
-
Due to financial reasons; It is cheaper to travel alone.
Her partner might not be able to take the time off work.
• How could her experiences with previous pregnancies and deliveries influence her feelings today? :
-
Recurring spotting and decreased fetal movement can increase her anxiety if she hasnt experienced these complications in
previous pregnancies.
She may feel confident since she has already gone through 5 full term pregnancies.
• Who holds the most power in the relationship you have with this client? What steps can you take to create a more balanced
dynamic? :
I/The nurse holds the most power in this situation. To create a more balanced dynamic it is important to listen actively and show
respect and empathy, respect her cultural beliefs and traditions, it is also important to involve Nadine in decisions about her care and
to educate her how to monitor fetal movements and recognize warning signs.
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2. Familiarize yourself with the OTAS document for this client and identify missing data to help you organize your
interview/assessment. How will you approach asking the social history questions? Reflect on the sensitive nature of these topics
and plan ahead to ensure that your approach is mindful and respectful :
- I’d start by introducing myself to the patient and explain the purpose of gathering the social history and explain that these
questions are standard. Let the client know they are not obligated to answer but they are important questions to help ensure your
safety and wellbeing. Also, by being non-judgemental and maintaining a neutral tone regardless of the patients answers.
3. By 35 weeks gestation, which diagnostics tests should be completed? Refer to the SINF 2035 course slides and the OTAS
document.
- Groupe B Streptococcus (GBS) Test
- Complete Blood Count (CBC)
- Non-Stress Test
- Diabetes (If not already completed)
4. What does a typical fetal tracing look like at 35 weeks gestation? What specific characteristics should be assessed?
- At 35 weeks' gestation a typical fetal tracing should have, moderate variability, presence of accelerations, and absence of
late/variable decelerations indicate a healthy fetal status.
Specific characteristics:
-
Fetal Heart rate
Contractions
Variability
Accelerations
Decelerations
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5. What instructions should be provided to a woman in her 3rd trimester returning to the community, to help her recognize when
she should return to the hospital :
We should educate the woman about the signs and symptoms of when to return to the hospital such as : Constant Abdominal or
lumbar pain or contractions, Regular Contractions, Sensation of pelvic pressure, The membranes break, Unusual need to urinate, Few
fetal movements, Red liquid vaginal discharge and Edema especially if suddenly and on the face.
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