9.14 Spotlight Activity

This spotlight activity will demonstrate a nurse using the nursing process and clinical judgment model to provide prenatal nursing care.

Situation/Background

Aria is a 28-year-old client who arrives at the obstetrics clinic for a routine prenatal checkup in the second trimester. The medical history reveals a healthy lifestyle with no underlying medical conditions. The client expresses an array of pregnancy-related symptoms that have been causing some unease.
The client reports experiencing mild but persistent nausea, especially in the morning, along with a lingering sense of fatigue that tends to intensify as the day progresses. As the client navigates through the changes, Aria expresses some anxiety related to the physical changes of pregnancy and would like a better understanding of the process of pregnancy.

Critical Thinking Questions

1. What assessment data should the nurse plan to collect?

The nurse should gather the following subjective and objective information to assess the client’s condition.

Subjective Data
• Severity and frequency of nausea (triggers, time of day, relief measures)
• Patterns of fatigue (daily activities, sleep quality, rest periods)
• Anxiety levels and concerns related to pregnancy
• Dietary intake and hydration status
• Exercise routine and daily physical activity
• Support systems and social support networks and coping strategies

Objective Data 
• Vital signs (blood pressure, heart rate, temperature, respiratory rate)
• Weight and body mass index (BMI) trends
• Fundal height and fetal heart rate
• Skin, mucous membranes, and signs of dehydration
• Edinburgh Postnatal Depression Scale (EPDS) – Can screen for both anxiety and depression in pregnant women.

2. Based on the assessment data what NANDA nursing diagnoses apply to this client?

• Nausea related to hormonal changes of pregnancy as evidenced by client-reported morning nausea.
• Fatigue related to increased metabolic demands of pregnancy as evidenced by reports of persistent tiredness.
• Anxiety related to concerns about physiological pregnancy changes as evidenced by excessive worry and seeking reassurance.
• Readiness for Enhanced Pregnancy management as evidenced by expressed interest in learning about pregnancy changes

3. What are some examples SMART Outcome Criteria for this client?
For Nausea:
“By the next prenatal visit, the client will report a decrease in nausea episodes, managed through dietary adjustments and relaxation techniques.”

For Fatigue:
“Within two weeks, the client will implement scheduled rest periods and report improved energy levels throughout the day.”

For Anxiety:
“By the next follow-up appointment, Lara will verbalize reduced anxiety about pregnancy changes and demonstrate understanding of normal physiological processes.”

For Readiness for Enhanced Pregnancy Management:
“Within one month, the client will actively engage in prenatal education, demonstrating an increased understanding of pregnancy and self-care techniques.”

4. What nursing interventions can the nurse plan to implement?

Managing Nausea:
• Educate on eating small, frequent meals and avoiding greasy or spicy foods.
• Recommend consuming ginger or peppermint tea, which may help alleviate nausea.
• Encourage hydration and suggest sipping water throughout the day.

Addressing Fatigue:
• Advise to incorporate short rest periods throughout the day.
• Encourage moderate physical activity, such as prenatal yoga or walking.
• Discuss proper sleep hygiene, including reducing screen time before bed.

Reducing Anxiety:
• Provide education on normal physiological pregnancy changes
• Encourage relaxation techniques, such as deep breathing or meditation.
• Suggest mindfulness or meditation exercise to ease pregnancy related anxiety

Readiness for Enhanced Pregnancy Management
• Offer educational resources on pregnancy changes such as prenatal classes
• Encourage involvement of support system (partner, family, or friends) in the pregnancy process.
• Suggest joining a prenatal support group or online community for additional guidance

5. Give examples of how the nurse evaluates if the interventions were effective (met or unmet). To determine if the nursing interventions were met, the nurse can assess the clients progress during follow-up visits and through ongoing communication. Here’s an example of how the nurse evaluates each intervention:

Evaluation of Nausea Management:
• The nurse asks, “Since implementing dietary changes and hydration strategies, have you noticed a reduction in your morning nausea?”
• The client reports that she still experiences mild nausea but finds that eating small meals and drinking ginger tea has significantly reduced its severity and frequency.
• Conclusion: The intervention was met but may need slight adjustments, such as further dietary modifications or relaxation techniques.

Evaluation of Fatigue Management:
• The nurse asks, “Have you noticed any improvements in your energy levels since adding rest periods and light exercise to your routine?”
• The client states that she feels more rested and energized in the morning, though she still experiences some fatigue in the evening.
• Conclusion: The intervention was effective but may require further reinforcement, such as adjusting Lara’s sleep schedule

Evaluation of Anxiety Reduction:
• The nurse asks, “How are you feeling about the changes in your body? Do you feel more confident about managing your pregnancy symptoms?”
• The client shares that she feels more informed and reassured after learning about normal pregnancy changes but still has occasional worries.
• Conclusion: The intervention was effective, but ongoing support, such as continuing prenatal classes, may be beneficial.

Evaluation of Readiness for Enhanced Pregnancy Management
• The nurse asks, “Did you find the online pregnancy support group helpful?
Did your partner/friend attend the pregnancy class?
• If the client reports increased knowledge, improved symptom management, and greater confidence in her pregnancy, the interventions are successful. If not, then outcome criteria are “Partially met” and making interventions such as adding further education and support.