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 her back, and during contractions you notice a few late decelerations of the FHR. You stay with M.J. to monitor her and the fetus and immediately call for someone to notify the PCP. 9. Put these actions in order of priority: 4 a. Discontinue the oxytocin infusion. 1 b. Turn M.J. onto her left side and elevate her legs. 3 c. Increase the rate of the maintenance IV fluids. 2 d. Administer oxygen at 8-10 L/min by facemask. As the nurse you are monitoring FHR patterns, beginning with the baseline FHR and variability. 10. What is included in monitoring baseline FHR and variability? Use of intermittent auscultation, continuous EFM via external or internal. 11. Define the 3 major deviations from a normal FHR and list at least 3 possible causes of each. Tachycardia- a fetal heart rate greater than 160. Possible causes: maternal/ fetal infection, fever, street drugs Bradycardia – a fetal heart rate lower than 110. Possible causes: vagal stimulation, maternal hypotension, fetal decompensation Absent – a fetal heart rate of irregular patterns. Possible causes: medications, fetal sleep, fetal hypoxemia 12. Along with baseline FHR, M.J. is monitored for periodic and episodic changes. Define each. Periodic- This is the variation in the fetal heart rate patterns that occur due to contractions. Episodic- These are variations in the fetal heart rate pattern that ARE NOT associated with contractions. 13. Periodic changes can be reassuring, benign, or non-reassuring. What is the significance of these patterns? State what the nurse should do for each type. Reassuring- spontaneous elevations of FHR above baseline by at least 15 bpm and lasting 15 seconds or more. This is reassuring and no intervention needs to be done. Benign- early deceleration of the FHR that mirrors the uterine contractions. As long as the baseline remains normal and the variability is good, there is no specific nursing intervention needed except or continue to monitor. Non-reassuring- a variable deceleration may occur at any point in a contraction. This could be caused by several factors but most commonly by compressing of the umbilical cord. The nursing interventions should be aimed for relieving the compression. 14. As you monitor M.J., you observe for prolapse of the umbilical cord. Describe what this is and what happens to the fetus if this occurs. This is when the umbilical cord is present through the opening of the cervix. This is dangerous because it could cause a drop in the fetal heart rate and a lack of oxygen supply for the baby. 15. What would be done if you noted that M.J. had a prolapsed cord? While holding the cord inside of the client, have someone call the doctor and assess the baby, making sure they are not on top of the cord. The remainder of the labor is uneventful; M.J. as an episiotomy to allow more room for the infant to emerge and delivers a male infant. 16. M.J. has her episiotomy repaired and the placenta delivered. What are the signs that the placenta has released from the uterine wall? The contractions will stop, and labor pains will subside after the baby is delivered. The placenta will separate and cause major painful cramps. 17. What assessments and interventions are important for M.J. following delivery? Assess urinary function, position, blood pressure, monitor the episiotomy site for signs of infection. 18. What are some methods that may be used for pain relief after delivery? Ask for some ibuprofen, (if doctor allows), offer a cooling pad or a heating pad for the postpartum woman to get herself on. A sitz bath can be used until the episiotomy wound heals. M.J. and her newborn baby boy are taken to the maternity unit where she begins to breastfeed him.