1128: Client reports that she is ‘looking forward to her delivery.’ She reports occasional foot and ankle swelling while on her legs for prolonged periods. This has become bothersome because her shoes feel tight at the end of the day. She has occasional backache, which is relieved by her doing shoulder circles. She reports that she has been constipated on occasion, and straining causes her to notice little spots of bright red blood after she wipes. She denies any trouble with sleep, but about two weeks ago, her legs became restless at night but it did not cause any issues with sleep. Over the past two weeks, she noticed that she had become more tired than usual and that someone mentioned that she looked unusually pale. She also began noticing daily headaches that lasted for a few hours. She also had to stop going to the gym because of what she describes as intense fatigue. Upon assessment, the client appeared pale and had dry skin. She is alert and fully oriented. Clear lung fields bilaterally. S1/S2/S3 heart tones auscultated. Peripheral pulses 2+. Fundal height is 30 cm. Fetal heart rate via Doppler was 134 bpm. She reports that the fetus moves about 10 times per hour. Denies having any vaginal discharge or burning with urination.

1129:

97.8° F (36.6° C)

P 93

RR 19

BP 133/79

Pulse oximetry reading 98% on room air

1215: Client showing evidence of iron-deficiency anemia. Point of care laboratory test showed a hemoglobin of 8.5 g/dL [10.5 g/dL - 14 g/dL] and low serum ferritin. This is supported by the client's restless legs, headache, fatigue, and pallor.

Two weeks later

Client Communication via Patient Portal

1400: I am feeling better and have more energy during the day. I still notice that my legs are restless at night. This is making my sleep difficult. My concern is that I am experiencing more constipation despite drinking more water. My stools are darker than usual. You told me to do kick counts, and the baby moves about 10 times an hour. My normal skin color has returned.