MATERNITY 101 Maternity Labor Case Study.

MATERNITY 101 Maternity Labor Case Study. Maternity Case Study You are working in labor and delivery at a local hospital. M.J. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask some important questions to determine your next course of action; that is, whether to do a vaginal exam or to continue asking more questions. 1. What important initial questions will you ask, and why? I would ask about the obstetric history such as the GTPAL, due date, complications with pregnancy, and any previous birth experiences. I would also as about the contractions, the time they started, the pattern if there has been any fetal movement in the last 24 hours. If there is a history of chronic illnesses. I need to know about the social history such as marital status, if there is a support system that needs to be called. I need to know if there are any plans for labor and plans for the newborn. 2. M.J. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy. She has a 3-year-old daughter at home who was born at 38 weeks and had a miscarriage 2 years ago. She states her due date is 2 days away. Her bag of waters is intact at this time. You determine that it is appropriate to ask for further information before a vaginal exam is done. 3. What is M.J.’ s GPTAL? G3 P0 T2 A1 L1 4. What other information do you need? I would ask and assess for any bleeding, allergies. I would ask if there is any history of hypertension, diabetes (including if she has/had gestational diabetes with this or any previous pregnancy). I think palpating the abdomen should be done to feel for a fetal heartbeat. Were there any complications with her other births? Upon examination, M.J. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit. 5. What laboratory studies do you anticipate the provider may order? Complete blood count (hemoglobin and WBC), blood type and Rh factors, Rubella titer, Urinalysis, vaginal and cervical cultures. 6. What nursing measures should be done at this time? There is not much to be done until she is completely effaced and dilated. The most that can be done is ensure comfort, safety and satisfaction during these stages of labor. We need to monitor her contractions and her baby’s fetal heart rate or any other signs of complications in labor. 7. M.J. states that she is feeling discomfort and asks you whether there is alternative therapy available before taking medications. List at least 4 alternative methods to assist M.J. with controlling her discomfort. Breathing, Hypnosis (if applicable), Acupuncture/Acupressure, Effleurage. 8. As you assess both the mother and the fetus during labor, you will look for abnormalities. Which of these are potential abnormalities during labor? Select all that apply. A. Unusual bleeding B. Brown or greenish amniotic fluid C. Contractions that last 40 to 70 seconds D. Sudden, severe pain E. Increased maternal fatigue Although M.J. continues to use alternative therapies for discomfort, she asks for pain mediation and receives a dose of meperidine (Demerol). Three hours later, M.J. is lying on