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Rosa (G2 T1 P0 A0 L1) is a 32 year old Hispanic-American woman in her 38th week of pregnancy. Rosa has been treated for gestational diabetes since her 28th week of pregnancy with fair glycemic control. Fasting sugar on admission 88 mg/dl early this am on admission at 6 am. Rosa states irregular contractions started yesterday morning at about 10 am. Contractions every 2-4 minutes, 50-60 seconds long and uncomfortable for the last 5 hours after gush of clear fluid from vagina. Rosa did not come to hospital sooner because she was unable to find babysitting for her 2 year old. Rosa has been unable to eat due to significant nausea with ongoing labor. Rosa is restless and uncomfortable with contractions. Assessment Leopold’s maneuver reveals large fetus in vertex position. FHT 130-145 with periodic increase to 168 for 10-20 seconds and no other periodic changes. Contractions with external monitor every 2-3 minutes 70-80 seconds duration. Vaginal exam (SVE) notes fetal head at -2 station with cervix 7 cm and 80% effacement and amniotic membranes ruptured with clear fluid noted.

Identify the stage and phase of labor Rosa is exhibiting.
List two possible complications for Rosa and her infant at this point of her labor.
Describe the ongoing assessment expected for Rosa’s labor at this time.
What action is anticipated to support Rosa’s blood sugar during labor?

After her delivery of this pregnancy, Rosa asks the nurse whether the health problem she experienced during this pregnancy will continue now that she has had the baby. She also wonders if it will happen with her next pregnancy because she wants to get pregnant again soon. Discuss the response the nurse should give to Rosa’s concern.

SCIENCE
HEALTH SCIENCE
NURSING
NUR 168

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