Assigned Unit Case Study Due Antepartum (High

Assigned Unit Case Study Due Antepartum (High Risk) Antenatal Labor & Delivery Labor Couplet Care Post Partum/Newborn High Risk Nursery, NICU High Risk Neonate LABOR CASE STUDY CRITICAL THINKING QUESTIONS 1. A pregnant client at 37 weeks’ gestation states calls the triage unit in Labor & Delivery. She states “I’ve had some mild contractions, they come and go pretty irregularly. They feel similar to a menstrual cramp. How will I know if I’m really in labor? How will you respond to her questions regarding true and false labor? What questions should you ask her to establish her labor status? 2. A client who has been diagnosed with severe preeclampsia is scheduled to be induced with Pitocin. She has a Bishops Score of 5. What care must be performed before starting Pitocin? What is the care of the client during the induction? Please make sure you address both the induction and care of a client with severe preeclampsia 3. The physician diagnoses severe fetal distress and orders a STAT cesarean section delivery. Describe the nursing interventions in preparation for this procedure (preoperative care); caring during the procedure (intraoperative care); and the care after the procedure (postoperative care). Explain the rational for each intervention. 4. A 20-year-old married (G1P0) kindergarten teacher, was admitted to the labor and delivery unit with contractions occurring every 3-5 minutes and lasting 50-60 seconds. The husband reports to the nurse that she is doing well with her breathing and that they are excited about natural childbirth. During the assessment the nurse finds no complications with the current pregnancy, no family or medical history. BP 128/64, P. 90, R. 24. She has spontaneous rupture of the membranes and the FHT decreases to 70. When the nurse does a cervical exam the cervix is 5 CM dilated100% effaced and feels something soft and oblong at the cervical opening. What do you suspect is happening? What is the care for this client? 5. Janet is a 37 year-old primigravida at 42 2/7 weeks ‘gestation. Her labor is being stimulated with Oxytocin 20 units in 1000mL of Lactated Ringers at 20mu; her moderate contractions occur every 3 minutes and last 65 seconds. She is currently in a supine position with a 30 degree elevation of her head. On observation of the monitoring tracing, you note that during the last six contractions the fetal heart rate (FHR) decreased after the contraction peaked and did not return to baseline until about 20 seconds into the rest period. Variability and baseline are unaffected. What type of fetal heart rate is this patient experiencing? What possible reason(s) is this patient is experiencing this type of FHR? How many mL/hour of Oxytocin is this patient receiving? What nursing interventions should you perform? 6. At 0800 a G1 P0 labor patient is 9cm / 100 /- 0. External fetal monitor shows the fetal heart rate (FHR) of 156 with a rapid decrease of 30 beats below the baseline lasting 15 -20 seconds before returning to the baseline before the contraction ends. The patient in a supine position. What type of fetal heart tones is this patient experiencing? What is the nursing care for this client? If the nurse fails to intervene: What legal right does the patient have? (Look at the Patient’s Bill of Rights) Compare the nurse’s actions to the BON position statement on the nurse’s duty to the patient. (Look at the Board of Nursing position statement 217.11) 7. Rosa is a G5P4, she was admitted to Labor and Delivery at 0930; she said her labor contractions started at 0730 this morning. Rosa has an IV of Lactated Ringers at 125mL/h and her consents are signed. At 10:00am Rosa states “The baby is coming!” You check her cervix and she is 10cm /100/ +2 the physician is called and they arrive just as the head is delivered. What type of labor is this defined as? Describe the nursing interventions to assure safety for the mother and the infant as you assist with the delivery. What is the possible reason Rosa’s delivery was so quick? 8 You are assisting Eva with the delivery of the baby. Every time she pushes the baby’s head crowns but then when the contraction stops the head retracts into the vagina. What do you suspect is happening? What is the nursing care for Eva at this time? 9. After a spontaneous rupture of membranes, the nurse notes that the fluid is green. What is the nursing care during labor and delivery for this infant? 10. Complete drug sheets for these medications and solve the drug problem A. Oxytocin Order is to begin labor induction with IV infusion of 2 milliunits per minute; and increase by 1 mu every 30 minutes until contractions are every 2 -3 minutes lasting 60 – 90 seconds. On hand is oxytocin 20 units in 1000 ml LR. State ml/hr to the set infusion pump at the beginning. The infusion was started at 0800 – what is the infusion rate mL/hr at 10:05am? B. Meperidine C. Narcan

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