Midwifery Plan of Care for a Woman Gravida: 2 Parity: Gestational Age: 35 weeks Cramping suprapubic discomfort dysuria frequency and urgency no fever. Assessment Findings Cramping Suprapubic Discomfort:Common in late pregnancy due to uterine growth Braxton Hicks contractions.However must be monitored any signs preterm labour or complications. Dysuria (Burning/Stinging) Frequency Urgency: Possible urinary tract infection (UTI) especially given the complaint dysuria frequency. No fever indicates that this may not an acute pyelonephritis but still requires investigation treatment prevent progression more severe complications such as labour. Absence reduces concern systemic pyelonephritis UTI needs addressed avoid (Queensland Health Antenatal Guidelines) & Clinical Findings: Discomfort: Common contractions. Should (regular contractions cervical changes). Dysuria Suggestive requiring investigation. likelihood does exclude UTI. Pyrexia (No Fever): Reassuring infection management remains necessary Monitoring: Vital Signs: Blood pressure pulse respiratory rate temperature foetal heart rate. Urinalysis: Dipstick test check indicators (e.g. nitrites leukocytes protein). Urine culture sensitivity confirm guide antibiotic choice. Abdominal Examination: Assess tenderness tone size. Monitor contractions changes. Palpate position. Foetal Heart Rate Ensure rate is within normal limits (110–160 bpm). Evaluate movements. B. Differential Diagnosis: • Urinary Tract Infection (UTI): Primary • Preterm Labour: Must ruled out if increase changes occur. • Round Ligament Pain: Consider discomfort intermittent positional. 2. Management A. Treatment: • Antibiotic Therapy: o Prescribe appropriate antibiotics based on results amoxicillin nitrofurantoin). o Ensure patient completes full course treatment. • Hydration: Encourage increased fluid intake support clearance. • Symptom Management: o Advise avoidance bladder irritants caffeine acidic foods). o Recommend warm compresses discomfort. • Rest Hydration: adequate rest. • Reassurance: o Mild cramping common at weeks should monitored. regular lower back pain vaginal discharge). • When Seek Help: o Contact healthcare provider becomes painful. 3. Patient Education Prevention: • Proper perineal hygiene (wipe front back). • Urinate after intercourse maintain hydration. Signs Preterm • Regular painful (increasing intensity frequency). • Changes discharge watery blood-tinged). • Pelvic low decreased movement. C. Monitoring Movements: • Educate daily movement monitoring. • Immediate contact with reduced movements are noted. D. Comfort Measures Cramping: • Use heat packs (not excessively hot) relief. • Gentle stretching exercises tolerated. 4. Follow-Up Culture Treatment Review: • Review urine 48-72 hours. • Adjust required testing. • Monitor symptom resolution. Care: • Continue routine antenatal visits (every 1–2 stage pregnancy). • Discuss postpartum contraception options. • Provide additional referrals needed pelvic floor physiotherapist lactation consultant). When Immediate • Persistent worsening cramping. • Signs bleeding rupture membranes). • Fever chills back/flank pain indicating possible pyelonephritis. Proposed Diagnostic/Screening Tests: 1. • Urinalysis (Dipstick Test): o Purpose: To detect blood. o Findings Note: ? Leukocytes Nitrites: Suggest infection. ? Blood Protein: Could indicate other issues like irritation serious pyelonephritis). ? pH Specific Gravity: Can help evaluate renal function status. • Urine Sensitivity: identify specific bacteria causing determine which will most effective. o Indication: If dipstick suggests symptoms persist despite initial management. o Turnaround Time: Results typically take o Consideration: essential diagnosis inappropriate use. Examination • Foetal (Non-Stress Test - NST): monitor distress ensure foetus compromised. A range 110-160 bpm. well-being concerning early • Palpation Abdomen: assess tone contraction tenderness. o Findings: distinguish between contractions) versus • Assessment moving normally indicator health. there concerns about could suggest distress. Cervical Exam (If Clinically Indicated): • Purpose: cervix dilating effacing • Indication: frequent worsening starting. • Consideration: This exam performed caution pregnancy risk factors • Complete Count (CBC): elevated white blood cell count) anemia can complicate pregnancy. develop there's spread • C-Reactive Protein (CRP) Erythrocyte Sedimentation (ESR): inflammation marker progressing 5. Group B Streptococcus (GBS) Screening Not Already Done): screen Streptococcus cause infections newborns during delivery. GBS screening done 35-37 it hasn’t been yet included visit. 6. Ultrasound labour length rule conditions kidney abnormal positioning worsen 7. Vaginal Swab potential bacterial vaginosis yeast infection). discharge) examination Summary 1. Urine (for screening). 2. Urine Sensitivity (to therapy). 3. Foetal well-being). 4. Abdominal Palpation contractions). 5. Cervical (if labour). 6. Blood CBC CRP/ESR complications suspected). 7. Group already done). 8. Ultrasound compromise). 9. Vaginal infections). These tests clarify diagnosis decisions safety well-being both mother foetus. Communication Plan/Results Information: • Gravida: • Parity: • Gestational • Presenting Complaints: frequency urgency without ________________________________________ Plan: Initial Testing: o Urinalysis (UTI) urine. o Urine We send your sample also us choose correct o We baby's they well. The 110–160 beats per minute we • Abdominal uterus tenderness differentiate • Management o We’ll focus relieving by ensuring you stay hydrated I provide comfort measures o If confirmed prescribe results so start immediately. • Patient Education: o I give advice recognizing how further UTIs proper drinking plenty fluids). (Post-Test): Results: shows leukocytes confirmed results. o Once receive (typically 48–72 hours) identified. you’ve started before result adjust them accordingly. • Next Steps Confirmed: you’re antibiotic we’ll over next few days make sure resolve. Exam: Rate: o The baby’s bpm) immediate feels premature just part stage. • Action o Continue report decrease Keep track increasing cramping Follow-Up: Steps: Once adjustments plan. prescribed antibiotics finish even improve. • Time Frame: Review Symptoms: • Cramping: Continue regular notice bleeding leakage please seek medical attention. persists treatment consider investigations. • UTI experience fever back/flanks) pyelonephritis) attention Movement: • Instructions: Track daily. significant movements go hospital assessment. have including Visit: schedule another appointment 1-2 weeks. During visit weight growth listen • If Symptoms Worsen: new symptoms discharge reach earlier appointment. • Education: You know including: o Regular o Lower o Pressure pelvis o A noticeable change • Action: these immediately evaluation. Summary: • We conducting today well-being. Based treat follow up resolves. • Keep particularly call decrease. week sooner needed soon them. Please don't hesitate questions meantime. communication ensures woman understands plan care what expect from steps follow-up when care. It reassures her health baby being carefully o Cramping o Dysuria (burning/stinging) (no fever) 1. Cramping o At attributed However 2. Dysuria o Likely indicated urgency. absence helps managed 3. No o Absence reassuring Actions: • Vital o Blood • Urinalysis: o Perform leukocytes). o Collect o Check size tone. o Monitor dilation). o Palpate o Measure (should o Assess (i.e. movements). o Send culture. o Evaluate ligaments o Encourage flush system. compress safe do so). rest drink fluids. o Reassure mild pattern intensity. o Educate discharge. • Instruct • Encourage urinating o Change blood-tinged) o Pelvic pressure o Decreased • Advise providers • Suggest using pads too relief encourage gentle exercises. therapy necessary. • Reassess hours resolution symptoms. Regular Prenatal Visits: • Schedule visit one week regarding care she experiences: o Severe o Fever chills (signs infection) Supportive Emotional Support: • Reassure emotional support. Lifestyle Adjustments: • Offer guidance work balance body positioning reduce deal stress. Discuss Future Family Planning: • Talk contraceptive options assist creating future. Hydration therapy rest reassurance • Monitoring Investigation: signs urinalysis culture prevention monitoring • Follow-up: check-ins review escalation worsen. comprehensive patient's appropriately while educating recognize