Albany Tower – Flat 1

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Claire

Claire went on holiday last Summer to Magaluf. She met a Spanish waiter while she was there and they became close and started a sexual relationship. She was taking the Pill and so hoped this would be an effective means of contraception. However one night she was violently sick after drinking a lot of Sangria and did not take any other precautions such as using condoms. On returning to England she realised she was pregnant and by the time she arranged to meet her midwife she was already 14 weeks pregnant. She thought about a termination of pregnancy and even asked at the hospital but then decided against the idea. She is still working, has no address for the dad and her family are very hostile to her decision to keep the baby. She has just started college after leaving school with 5 GCSE’s.

  1. Where could Claire have found help with her decisions about the choices available to her if she had not felt ready to keep her baby?
  2. What rights and benefits may Claire be entitled to at present and if she has to give up work?
  3. Using a PISCES model think of one thing that may affect each of the following in relation to Claire’s wellbeing:

PHYSICAL
INTELLECTUAL
SOCIAL
CULTURAL
EMOTIONAL
SPIRITUAL

  1. Using the latest NICE Guidelines identify what are the key things the midwife needs to ask when Claire “books” with you as her community midwife
  2. What are some of the issues when a women “books” when she does not know much about the father’s medical history as in this case?
  3. What other multi-disciplinary agencies could the community midwife encourage Claire and her family to contact to support them once Claire has her baby?
  4. At this 1st antenatal visit as the named midwife you will be expected to offer and carry out a number of tests and procedures today.
    1. When would you next weigh baby Kylie?The last LNMP for Claire was 1st July 2019.Calculate her EED?Calculation of BMI:BMI=weight in kilograms

      (Height in metres)2

      Her height is 165 cms

      Her weight today 50 Kgs

      Her BMI is 16.3. This is classed as underweight.

       

      1. What are some of the possible reasons for being underweight?
      2. What are some of concerns re being underweight and pregnant?

      Review NICE guidelines NICE (2017). Eating disorders: recognition and treatment NICE clinical guideline 69. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng69/ifp/chapter/Eating-disorders-the-care-you-should-expect

       

      On further discussion Claire shares that she has suffered from eating disorders in the past

      1. What support groups are available for you to refer Claire to fro support with her eating disorder?
      2. What blood tests will be offered to Claire today?
      3. How to take her blood pressure – any considerations?

       

      At subsequent scans in her pregnancy she is advised that baby is showing signs of poor growth and Claire is obviously anxious when she rings you after her appointment at the hospital asking “what does IUGR” stand for as he has seen this written in her notes.

       

      Claire births Kylie at 36 weeks vaginally after a short labour at the local hospital accompanied by her friend Amy.

      Kylie weighs 2.3Kgs and both Claire and Kylie are transferred home the next day.

      Claire rings you on day 3 saying that Kylie is very sleepy and not wanting to take her bottle milk.

      1. Before you visit what questions would you ask Claire?
      2. What would be your plan of care?

      Using a

      SBAR approach

      Situation:

      Background:

      Assessment:

      Recommendation: