Maternity_VSim_Case_2_Brenda_Patton,WELL EXPLAINED WITH VERIFIED ANSWERS.

Brenda Patton is an 18-year-old Caucasian female, G1P0 at 38 2/7 weeks of gestation admitted to the labor and birthing unit for labor assessment. The patient states that her water may have broken earlier this morning and she thinks she is in labor. AmniSure was positive (AmniSure is a rapid, non- invasive test that aids in the detection of ROM in pregnant women with signs and symptoms suggestive of the condition. It provides an easy-to- interpret, accurate, and timely diagnosis that enables clinicians to take opportune measures to prevent complications) . Vaginal exam reveals 50% effacement of cervix, cervical dilation 4 cm, and fetus at -2 station. The patient's boyfriend is present, and she has phoned her mother to inform her of her admission. The provider has been notified, and prenatal records have been pulled. The lab report indicates that the patient's group B strep vaginorectal culture taken at 36 weeks was positive. The patient wishes to have a natural birth without medication. Admission intrapartum orders have been initiated, initial labs have been drawn, and a saline lock has been placed in her forearm. Readings and applicable PowerPoint: Readings ● Group B Streptococcus, p. 85 ● Continuous External Monitoring, p. 359 ● Promoting Comfort and Providing Pain Management During Labor, Chapter 14 ● Overview of a Woman in the Active Phase of the First Stage of Labor, Chapter 16 ● Pregnant Adolescent, pp. 40 PowerPoint: ● Intraprtum Comfort Management ● Fetal Assessment ● Intrapartum I & II Diagnostic Testing ● Prenatal Lab values (CBC) ● External fetal monitoring Pharmacology ● Penicillin G potassium Penicillin G potassium ● Promethazine hydrochloride Promethazine hydrochloride Pre-Simulation Reflection 1. Based on the patient background information what is your primary concern? What is your reason for this concern? - my primary concern would be attributed to the mother’s positive GBS test, which could very well be transmitted to the fetus during the birthing process, as well as risk for additional infection due to SROM 2. What complications can occur if the patient condition is not treated? - if not treated, it could be transmitted to the fetus, resulting in sepsis. Once septic, the child could experience mental retardation as a result of hypoxic ischemic encephalopathy and even death. 3. Based on this patient’s condition what data will be important to collect in your assessment of the patient? Why? - when exactly does she believe her water broke - ROM longer than 18 hours increases risk of infection - all maternal VS, especially maternal temperature - fever will increase risk to newborn - fetal assessment; continuous EFM - IV antibiotics - confirm fluid is indeed amniotic fluid 4. What labs are important to monitor in a patient with this condition? Why? - GBS cultures - WBC to assess for infection - MATERNAL VS - esp HR and temp - CEFM 5. What medications are used to manage this condition? - antibiotics, namely penicillin 6. What procedures are important to complete in a patient with this condition? Why? - begin IV penicillin immediately, as this will lessen the likelihood of transmission to fetus; infusion must occur at least 1 hr prior to birth - assess maternal vitals to monitor for infection - assess amniotic fluid and fetus to monitor fetal status, as well as confirm amniotic fluid is indeed amniotic fluid - educate mother of the causes and effects of antibiotic administration, as well as risks in refusing treatment Patient Education 2 Based on your virtual simulation experience what one area do you feel your patient needs the most education on? She acknowledged understanding of the need for the antibiotics, so my priority would likely shift to the contractions and FHR and what they mean in regards to wellbeing. List three specific points you would highlight in your education. 1. Explain the purpose for penicillin and the possible outcomes if not administered. 2. Explain the need to monitor temperature, BP, and FHR regularly. 3. Explain the meaning of contractions in the context of readiness for birth, and what to expect beyond. 3 CAPITAL UNIVERSITY DEPARTMENT OF NURSING CARE PLAN TEMPLATE Nursing Diagnoses [Include patient data justifying dx followed by NANDA diagnostic statements]. List all relevant diagnosis, develop the priority. 6 Points Expected Outcomes [NOC Label, Behavioral statement and Measureable Outcome Indicators with time frames] 6 Points Nursing Interventions [NIC Classification Label followed by specific Nursing Intervention Activities] 6 Points Evaluation [Eval of outcome status, eval of interventions r/t outcome status & statement of revisions required.] 7 Points Risk for infant infection r/t rupture of membrane and exposure to GBS pathogen. Knowledge deficit r/t health literacy and unfamiliarity of resources aeb maternal insistence on natural birth, despite positive GBS culture. Risk for acute pain r/t intrapartum status and lack of therapeutic regimen aeb maternal insistence on natural, medication free birth. Patient will be able to explain GBS, the need for antibiotics (penicillin), and the effect on fetus with omission immediately after education. Patient will describe the rationale for IV penicillin and the risks involved with omission immediately after education. Nurse will use client-centered approaches that will engage client as an active learner by involving patient in decision making, while considering well being of fetus. Nurse will reinforce learning through repetition and frequent call-backs to patient. Consider the context, timing, and order of how information is presented, ensuring that fetal safety is paramount. Nurse was able to educate the patient on the need for prophylactic IV penicillin. Patient was able to acknowledge understanding. Met. Nurse was able to reinforce learning by continuously teaching and explaining the need for treatment. Met. Nurse immediately explained the need for IV prophylaxis and assessed IV sit on patient upon entering the room. Patient was able to acknowledge understanding. Met. 5 Laboring Woman Situation If they had a patient with abnormal findings, they would report that here. Brenda Patton is an 18-year-old Caucasian female, G1P0 at 38 2/7 weeks of gestation admitted to the labor and birthing unit for labor assessment. The patient states that her water may have broken earlier this morning and she thinks she is in labor. The lab report indicates that the patient's group B strep vaginorectal culture taken at 36 weeks was positive. Background Brenda Patton is an 18-year-old Caucasian female, G1P0 at 38 2/7 weeks of gestation The patient's boyfriend is present, and she has phoned her mother to inform her of her admission. The provider has been notified, and prenatal records have been pulled. The patient wishes to have a natural birth without medication. Admission intrapartum orders have been initiated, initial labs have been drawn, and a saline lock has been placed in her forearm. Assessment Vaginal exam reveals 50% effacement of cervix, cervical dilation 4 cm, and fetus at -2 station. The lab report indicates that the patient's group B strep vaginorectal culture taken at 36 weeks was positive. Patient having strong contractions 4 minutes apart. FHR showing variable accelerations; no signs of brady/tachycardia 6 Recommendation Monitor maternal contractions and FHR continuously. monitor maternal temperature (temp increase increases risk for fetal sepsis w/GBS positive test) Administer IV penicillin prophylaxis Maternity Case 2: Brenda Patton Guided Reflection Questions Opening Questions How did the simulated experience of Brenda Patton’s case make you feel? I felt very confident being able to monitor her well being, as well as administering the appropriate IV antibiotics. Describe the actions you felt went well in this scenario. I was able to quickly conduct my assessment and vitals, and begin IV penicillin. From there, I was able to education the patient and provide comfort where needed. Based on your experience with Brenda Patton’s case, reflect on possible nursing actions for enhanced safety and quality improvement. Since she was experiencing regular contractions, I would have liked the ability to change position to maintain optimal comfort. Concluding Questions Reflecting on Brenda Patton’s case, were there any actions you would do differently? Explain. I did have a single one star error which told me I should have educated the patient immediately, which, considering the importance of the penicillin, would be important to establish promptly. Describe how you would apply the knowledge and skills that you obtained in Brenda Patton’s case to an actual patient care situation. 7 Understanding the results of a GBS positive culture, as well as the nursing actions (IV penicillin, monitoring FHR, and maternal temp) is something that I feel much more comfortable with. Great job! #6 needs a little more explanation. I know you know the answers, its just a loaded question. Once that gets fixed up, all satisfactory. 8