Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which patient?
1. 28-year-old with history of rheumatic heart disease
2. 18-year-old with exposure to HIV
3. 20-year-old with a history of preterm labor
4. 35-year-old with a child with spina bifida
4
Rationale 1: The patient with rheumatic heart disease would need to be monitored for pregnancy and the stressors it places on the patient.
Rationale 2: The patient with HIV exposure needs HIV testing and protection education.
Rationale 3: The patient with a history of preterm labor needs education on prevention and on signs and symptoms of preterm labor.
Rationale 4: Alpha-fetoprotein (AFP) is elevated in multigestational pregnancies and in pregnancies with neural tube defects such as spina bifida and Down syndrome. The 35-year-old is considered to be of advanced maternal age and is at risk for having a child with Down syndrome. With the past history of a child with spina bifida, this patient would be strongly encouraged to have the AFP screening.
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