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Exam (elaborations)

MATERNITY 101 Maternity Labor Case Study.

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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.

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