Case #2: Natalie

Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off of work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32 week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and sepsis infections. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32 week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.

Complete the following chart:

• Subjective data, identify both given and needed data
• Objective findings, identify both given and needed data
• Diagnostic or laboratory testing needed with rationales
• List of three differential diagnoses with rationales
• Medications and or treatments needed with rationales
• Patient education needed
• Referrals for collaborative care needed with rationales
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• Include relevant subjective and physical objective findings.
• Identify appropriate diagnostic and laboratory testing needed.
• List at least three differential diagnoses with rationales for choosing.
• Identify usual medications, treatments, or patient education needed.
• Determine referrals for collaborative care.
• Summarize the case study and include any further research, diagnostics, procedures, or follow-up needed.
• Provide evidence-based references.