Now that you have completed a series of assignments that have led you   into the active project planning and development stage for your   project, briefly describe your proposed solution to address the   problem, issue, suggestion, initiative, or educational need and how it   has changed since you first envisioned it. What led to your current   perspective and direction?

 

Research Proposal Draft

By the due date assigned write a 2-3-page paper addressing the sections below of the research proposal.

Introduction

• Background and Significance of the Problem
• Statement of the Problem and Purpose of the Study

Research Questions, Hypothesis, and Variables with Operational Definitions

• Research Question
• Hypothesis: Research and Null
• Identifying and Defining Study Variables
• Operationalize Variables

 Reply Amanda

Question #1

An ultrasound in third trimester could show many clinical indicators of fetal well-being.  First it shows us the fetal number-which most likely is already known.  It also shows us the baby’s presentation.   “If breech, describe the “type” of breech” Frank, Complete, Incomplete, Footling” (TOP, 2017).  This ultrasound will also tell us the fetal biometry and estimated fetal weight, Amniotic Fluid Volume, Placentation, Fetal movements, and Consider re-visualizing select fetal anatomic structures when a third trimester assessment is being performed (TOP, 2017). Its also important to check the babies heart tones and the mother’s vital signs, particularly the blood pressure.  Always ask if the mother is having any bleeding, leaking, constant contractions and is she feeling the baby move well.  It is also important to check the mother’s urine. 

Steps to take if findings are not reassuring during third trimester depend on the finding.  If the baby is breech.  External cephalic version is one way to turn a baby from breech position to head down position while it’s still in the uterus. It involves the doctor applying pressure to your stomach to turn the baby from the outside(Healthline, 2018).  For high blood pressure and signs of preeclampsia, “You may have to stay at the hospital for observation and to manage your blood pressure until the baby is old enough for delivery. If your baby is younger than 34 weeks, you will probably be given medication to speed up the baby’s lung development”(Healthline, 2018).  For most findings that are not reassuring the patient will be sent to the hospital for monitoring for mother and baby.

Healthline. (2018). What Might Go Wrong in the Third Trimester?. Retrieved on February 23, 2019 from https://www.healthline.com/health/pregnancy/third-trimester-complications#post–term

Toward Optimized Practice (TOP). (2017). THIRD TRIMESTER FETAL WELL-BEING STUDIES: CRITERIA AND MANAGING RESULTS.  Retrieved on February 23, 2019 from http://www.topalbertadoctors.org/download/2129/Third%20Trimester%20Fetal%20Well-Being%20Studies.pdf?_20180914050143

 Reply Hollie

Question 1—Third Trimester

Fetal growth is an important part of fetal assessment in the third trimester. Studies show that poor fetal growth in the second and third trimesters are associated with increased risks of preterm birth, low birthweight, and long-term adverse health outcomes (Gaillard, Steegers, de Jongste, Hofman, & Jaddoe, 2014). Fundal height is often used to assess fetal growth. If fundal height differs by 3 cm or more from gestational age, a follow-up ultrasound is advised to assess further (McCowan, Figueras, & Anderson, 2018).

Fetal heart rate and fetal activity should also be routinely assessed. The mother should be asked about fetal activity. Counting the kicks should be highly encouraged starting at week 28 (Bryant & Thistle, 2019). A kick count of less than 10 in 2 hours may be cause for concern (Bryant & Thistle, 2019). Fetal heart rate should also be assessed at every prenatal visit in the third trimester (ACOG, 2018). A typical fetal heart rate is between 120 and 160 beats per minute. Changes in fetal activity or fetal heart rate indicate a need for further testing. A non-stress test and/or a biophysical profile (BPP) may be ordered when results are nonreassuring (ACOG, 2018). A biophysical profile is an ultrasound that assesses: fetal breathing movement, fetal movement of the body or limbs, fetal tone and amniotic fluid volume (Bryant & Thistle, 2019).

Maternal blood pressure, urinalysis, and degree of edema are also important measurements that can affect the health of the fetus (Zolotor & Carlough, 2014). Blood pressure measurements can help identify chronic hypertension or hypertensive disorders that develop during pregnancy, such as preeclampsia or gestational hypertension (Zolotor & Carlough, 2014). Edema may be a normal finding but can also be a sign of preeclampsia (Zolotor & Carlough, 2014). Protein in the urine may also indicate preeclampsia risk (Zolotor & Carlough, 2014). These findings may also suggest the need for blood tests, fetal ultrasounds, nonstress tests, or a BPP (Zolotor & Carlough, 2014).

Lastly, fetal presentation is encouraged to be assessed beginning at 36 weeks gestation (Zolotor & Carlough, 2014). This is most often done using the Leopold maneuvers (Zolotor & Carlough, 2014). External cephalic version may be used to turn a fetus from a breech or transverse position into a vertex position before birth (Zolotor & Carlough, 2014).

References

ACOG. (2018). Special tests for monitoring fetal health. Retrieved from https://www.acog.org/Patients/FAQs/Special-Tests-for-Monitoring-Fetal-Health?IsMobileSet=false#exam

Bryant, J. & Thistle, J. (2019). Fetal movement. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470566/

Gaillard, R., Steegers, E. A., de Jongste, J. C., Hofman, A., & Jaddoe, V. W. (2014). Tracking of fetal growth characteristics during different trimesters and the risks of adverse birth outcomes. International Journal of Epidemiology, 43(4), 1140-1153. https://dx.doi.org/10.1093%2Fije%2Fdyu036

McCown, L., Figueras, F., & Anderson, N. (2018). Evidence-based national guidelines for the management of suspected fetal growth restriction: Comparison, consensus, and controversy. American Journal of Obstetrics & Gynecology, 218(2),855–868. doi: 10.1016/j.ajog.2017.12.004.

Zolotor, A., & Carlough, M. (2014). Update on prenatal care. American Family Physician, 89(3), 199-208. Retrieved from https://www.aafp.org/afp/2014/0201/p199.html

Edited by Hollie Finders on Feb 24 at 2:57pm Reply 

  

 
 

1-, remarkable presentation, just to add on I would recommend the physician if he/she can consider treating the patient with hyper baric oxygen in order to increases oxygenation to the tissue, improves circulation and blood flow, to increase the ability of neutrophils to kill the Mucar and to decreases the pain and swelling.

Thank you

 
 

2-There really isn’t enough information to determine if this patient really warrants an ICU admission. Where I work, our Progressive Care Unit could most likely manage this patient. Depending on the presentation, such things to consider are vitals, face to face assessment data, respiratory efforts, heart rate and rhythm. The chest xray does show white out of the mid to lower left fields but is clear at the left apex and to the right. Hard to determine the appropriate level of care based on the limited data provided.

 

 
 

3-Hyperbaric oxygen would help this patient because hyperbaric therapy increases oxygenation to the tissue, improves circulation and blood flow, boosts white blood cells especially neutrophils, enhances effectiveness of antibiotics, and decreases pain and swelling

(Latham E., 2018). However, there is some precaution while taking this treatment “the fire hazard” because the use of oxygen is always high risk to fire explosion. so, any material that can explode fire is prohibited in the treatment room, for instance nurses must make sure that the patient is not using a hair spray, deodorant, electric devices or cigarette lighter and proper education should be given to the patient (Latham E., 2018).

Reference

Latham E. (2018) Hyperbaric Oxygen Therapy retrieved [online] from: https://emedicine.medscape.com/article/1464149-overview

 

4-I enjoyed reading your post. Over the years, I have had many diabetic patients that are diagnosed with pneumonia, but never with Mucor. You stated, “Mucor is most commonly found in uncontrolled diabetics, transplant patients, cancer patients, and others who are immunocompromised (Centers for Disease Control and Prevention, 2015).” It is interesting to know that Mucor is commonly found in uncontrolled diabetics. However, I found that there have also been cases found in well controlled diabetics. According to Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014) “Uncontrolled diabetes, particularly diabetic ketoacidosis, predisposes patients to the development of mucormycosis; however, cases have been described even in patients with well controlled diabetes mellitus.”

Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014). Pulmonary Mucormycosis Presenting as Nonresolving Pneumonia in a Patient With Diabetes Mellitus. Retrieved  from http://rc.rcjournal.com/content/59/12/e201

 

5-I agree, a sputum or tissue sample like biopsy is needed to identify the fungal infection. However, amphotericin B, posaconazole or isavuconazole iv  are very effective treatments if started early and aggressively. In addition to this and an excision of the infected tissue or organ is also needed to save the rest of the tissue or organ and life as well. Nice post.

 

6- Nice post, I agree, once patient is on bed rest and NPO,  pantop and low molecular weight heparin needed to be started as gastric and  DVT prophylaxis. And this patient is going to be very unstable so needed to be admitted in ICU for monitoring and further management.