Labor Case Scenario: You are the staff

Labor Case Scenario: You are the staff nurse working in labor and delivery at a nearby local hospital. Analyn, 29 years old, 39 weeks AOG, gravid for the second time, comes to the admitting unit having contractions and feeling somewhat uncomfortable. On admission, she appears restless, has a dry mouth, and has a heartbeat of 101 beats per minute. You take the assessment and assisted her to change her street clothes into a patient’s gown and ask her questions to determine your next action. Upon seeing the facial expression noted on her face and the initial assessment made, you then inform Dr. Ong the Obstetrics about Analyn’s status. Dr. Ong then informed Analyn that she needs to check and will do an internal examination to verify the true signs of labor. The OB then ordered to prepare the patient for vaginal examination. The staff assigned prepared the patient first by telling her to empty her bladder first before the start of the procedure. A few minutes later, prepping, and perineal flushing was done for the physician to initiate the internal examination. The physician stated that Analyn is 80% effaced and 5 cm dilated, with an intact bulging bag of water. The patient has regular contractions 4 to 5 minutes apart and lasting 40 seconds. While the patient was being transferred to the labor area for contraction and FHT monitoring, the staff nurse safely secures the patient on her bed and instructed the patient that she will be attached to an Electronic Fetal machine (EFM) to determine the contractions, fetal heart tone, and fetal movement. Making ready for the EFM attachment, the nurse begins to do Leopold’s maneuver to identify the fetal presentation and position and to locate the fetal back for placement of the diaphragm of the stethoscope. The fetal heart tone (FHT) ranges from 133 to 155 beats/minute. An hour had passed, the patient called the attention of the nurse, stating “something came out that looked like water, but I’m not sure if it was urine”. The nurse then inspects the perineum to determine to what extent the process takes place, and at the same time assures that fetal structure was not yet seen in the vaginal opening. A few minutes later, Dr. Ong had her IE again to confirm that the bag of water has ruptured, which reveals a light yellowish color with little white specks on it. And has a relevant change with the cervical dilatation to 8cms now, with a thinner lining of the cervix. While transferring the patient to the delivery table, Analyn is having frequent, strong palpation contractions that are extremely uncomfortable. She is trembling, complaining of nausea and an uncontrollable urge to push. A few minutes later she went in normal labor and delivered a healthy single baby boy with an 8 Apgar score at birth and 9 Apgar score at 5 min. She sustained a second-degree perineal laceration which was repaired, and sutures were applied. Oxytocin (Pitocin) 10 IU 1 ampoule incorporated to present IVF of D5LR@1L and regulated at 120 mL/hr. Past Medical History: Her family history revealed no here do-familial diseases for both of her parents. No other reported diseases except for allergies to shrimps and chicken. Levocetirizine dihydrochloride (Allerzet) 5mg OD 1 tab at HS PRN as ordered for her allergy. She reported that she was able to complete the two doses of her immunization given at their health care center Prenatal Care: 1st trimester: had a regular prenatal check-up every month. 2nd trimester: Quickening was felt on 18 weeks AOG and continued to perceive fetal movements. 2 doses of tetanus toxoid were administered. An anomaly scan was done at 12 weeks AOG. No history of pedal edema, epigastric pain, blurring of vision and headache, No leaking or bleeding per vagina. 3rd trimester: She continued to perceive fetal movements. Calcium and Ferrous sulfate tablets were taken. Obstetric History (Menstrual and Pregnancy Hx) The patient had her menarche @ 12 years of age. She had regular menstruation. She usually changes her pads 3 to 4 times a day and is soaked in the first 2 days and moderate to light flow in the succeeding days. Last menstrual period 39 weeks ago Uncomplicated pregnancy to date, one prior full-term vaginal deliveries IBOW, no bleeding, painful contractions every 4-5 minutes No history of sexually transmitted infections No significant past medical or surgical history Allergic to shrimp and chicken COMPREHENSIVE PHYSICAL ASSESSMENT: Vitals: blood pressure 90/60 mmHg, heart rate 101 bpm, respiratory rate 17 CPM, temperature 37.6 C° FHT: 133 – 155 bpm IE upon admission: 80% effaced and 5 cm dilated Abdomen: term uterus, fundal height 39 cm, cephalic, otherwise soft, non-tender Hemoglobin 12.1 g/dL Blood type O+, antibody screen negative Question: Can you make a General Objective for this case scenario? Introduce the case scenario. Why there is a compelling need to study the case? Overview of the subject (patient being studied) of the study. THANK YOU

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