You are a registered nurse (RN) working in a Women’s OB/GYN Clinic

You are a registered nurse (RN) working in a Women’s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jones’s medical and obstetrical history is as follows.

Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papilloma virus (HPV), colposcopy within normal limits

Medical history: Chronic hypertension (HTN) x 5 years;

Allergies: Penicillin

Social history:

• (+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” for 15 years
• (+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use
• Abusive partner with first pregnancy, states she has a new partner x 4 years
• Depression, currently not taking meds for treatment (tx)

Medications: Prenatal vitamins; Labetalol 200mg BID;

Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)

1. What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?
2. What concerns should be discussed with Ms. Jones before she leaves her appointment?