L.Y. is a 17-year-old Hispanic female who comes to you at 20 weeks gestation. This is her first prenatal visit and she has gained five pounds since she has become pregnant. She has never had a pelvic exam. She had to quit school due to the pregnancy and works at a factory loading trucks with boxes of pesticides. She decided it was better to stop smoking, and two weeks ago she finally quit. She still occasionally smokes marijuana, stating that it helps her to relax. L.Y. is not sure who the father of the baby is. She has had four possible partners but has not told anyone yet. She lives with her mother and three brothers. Her mom works two jobs and is rarely home. Upon physical exam you notice the fundus is two finger breadths below the umbilicus at 18 cm, FHT’s are 145, and her cervix is bright red and bleeds from the pap smear. Her BP is 136/82, pulse is 78, respiration 20, and temp is 37.2? C. Her breast and thyroid are within normal limits. The bimanual exam is normal without cervical motion pain, uterine, or adnexal tenderness.Answer the following questions:What are L.Y.’s risk factors, and how can they be managed?What diagnostic tests would you administer and why?What would you include in a nursing therapeutic management plan, using ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation), for the treatment of the conditions that place L.Y.’s pregnancy at risk?
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