Question

Case Study #3

Read the instructions and questions in the case study below. All answers should be complete, include rationale, and have a citation. This assignment is graded by rubric in the Syllabus and Important Documents.

Scenario

1. The couple have expressed a desire for non-pharmacological pain control during the labor. Describe the Gate-Control Theory of pain and discuss three methods of assisting the couple to achieve their goal of non-pharmacological pain control during the labor.

2. The client calls the unit and tells a nurse that she thinks she is in labor. "I have had some pains for about 2 hours. Should my husband bring me to the hospital now?” Describe how a nurse should approach this situation.

3. Write at least 3 questions a nurse would ask to elicit the appropriate information required to determine the course of action required. (Write out as if you were the nurse answering the phone)
4. Based on the data collected during the telephone interview, the nurse determines that Mercy is in very early labor. Because she lives fairly close to the hospital, she is instructed to stay home until her labor progresses. Outline the instructions and recommendations (cite references and provide rationale) for care Mercy and her husband should be given for the nursing diagnosis: Readiness for enhanced knowledge of labor progression RT lack of exposure
5. A week later, Mercy arrives to Labor and delivery at 39 weeks gestation. A nurse uses Leopold’s maneuvers to assess the position of the baby in the uterus. A soft round mass is felt in the fundal region. A flat object is noted on the left and small objects are noted on the right of the uterus. A hard round mass is noted above the symphysis. The nurse would document which position consistent with these findings?
6. The nurse notes on the labor record that the fetal heart tracing has the following: contraction frequency every 3 minutes, fundus palpates the same consistency as the forehead at the peak of contractions; fetal heart tones 140 bpm, early decelerations with each contraction and return to baseline, variability moderate. Explain what this assessment means.
7. D.H. is admitted to labor and delivery for a labor induction with pitocin. Describe the procedure for pitocin induction.
   1. What are the nursing responsibilities for safe administration of pitocin?
   2. What are three potential complications?
8. D.H. complains of increasing headache, proteinuria is +3, and DTR’s are +3. Vital signs include Bp 154/94 mmHg, pulse 92. What is the primary concern based upon this assessment?
9. The physician orders magnesium sulfate infusion 4 gram bolus over 30 minutes, then 2 gm per hour. The pharmacy sends up an IV bag of 1 liter Lactated Ringers with 40 mg magnesium sulfate for a secondary line. Describe the procedure for magnesium sulfate infusion.
   1. What is the purpose for administering this medication?
   2. At what rate will the bolus be administered in mL/hr?
   3. Describe the adverse effects of magnesium sulfate administration.
   4. What are the nursing responsibilities for safe administration of MgSO4?

Answer 1

Procedure for Pitocin induction:

Pitocin is synthetic type of oxytocin hormone.It can be produced by the body during pregnancy,it play major role during labour by stimulating the uterus.

Pitocin induction: It is one of tool physician can be used to induce labour to speed the progress of labour. It can trigger contraction with in 30min.

During the procedure

There are various methods for inducing labor:

Ripen cervix:This can performed by using synthetic prostaglandins are placed inside the vagina,are used to soften the cervix.After the usage of prostaglandin,contraction and heart rate should be monitored.In other case ,catheter should be inserted into the cervix. Filling of balloon with saline and resting that helps to ripen the cervix.

Gynecologist should administer Pitocin given through an IV drip. It should be given small doses and increase gradually untill the contraction with in two to three minutes.Baby's heart beat should be monitored untill delivery.If induction fails C-section should carried out

a) Nursing responsibilities for safe administration of pitocin:

Dosage and administration:

Dosage and Administration:Perenteral drug should be inspected visually for particulate matter and discoloration. Dosage can be determined by the uterine responses,

1.Induction of labour:

• An IV infusion of non oxytocin Containing solution should be started.
• Oxytocin 1ml,10uspUnits/ml is combined with 1000ml of non hydrating diluent.
• The combined solution rotated in the infusion bottle to ensure thorough mixing containing 10mU/ml.
• The initial dose should not be more than 1 to 2mU/min and dose should be gradually increased to 2mu/,min untill the contraction has been established for normal labor.
• Monitor fetal route,uterinetone and frequency,duration and force of contraction.
• Oxytocin should be discontinued immediately of uterine hyperactivity

2.Control of postpartum uterine bleeding : Oxytocin of 10 to 40 units may be added to 1000ml electrolyte solution.

    IM administration:1ml of oxyocin can be given after delivery of the placenta

3.Treatment for Incomplete abortion:500ml of physiologic saline solution or 5% dextrose in physiologic saline solution to 10 units of oxytocin should be added and it can infused at a rate of 20 to 40drops per minute.

b) Based of the above three complications:The condition is seen in pre-eclampsia condition

Procedure for Magnesium sulfate infusion:

Preparation of magnesium sulfate solution:

Wash hands throughly with soap or alcohol and air dry.Using 20ml syringe ,draw 12ml of sterile water for injection.If 50 % of magnesium sulfate is available add 8ml of magnesium sulfate solution to 12ml of sterile water to make 20ml of 20% solution.

Administration of loading dose:

• Establish an Iv line using normal saline.
• Using a 20ml syringe,draw4g of magnesium sulfate 8ml mix with 12ml sterile water ti the same syringe.
• Give this 4g of magnesium sulfate solution over 20min.
• Using a two 20ml syringe,draw 5g of magnesium sulfate in each.
• Add 1ml of 2%lignocaine to each of two syringe.Inject 1st syringe by deep Im injection into buttock (5g magnesium sulfate).Inject 2nd syringe via IM into other buttock.
• If convulsion reoccur after 5minutes,administer 2g of magnesium sulfate by IV over 5minutes.

Administration of maintenance dose:

• Before administration:Monitor respiratory rate is a 16/min.Urinary output is at least 30ml/min over 4hrs.
• Give 5 gms of magnesium sulfate together with 2% lignocaine in the same syringe via IM.

a)Purpose of Magnesium sulfate:

• Pre-Eclampsia
• Eclampsia
• Toxemic of pregnancy
• Pediatrics acute nephritis
• Hypomagnesemia
• Barium poisoning
• Hemodialysis
• Pernatal asphyxia
• Laryngeal spasm

b)Toxemia of pregnancy:4-5g mix with 250ml in combination with either upto 10g of 20ml of undiluted 50% solution administered IM into each buttocks.After initial IV dose,1-2g/hr IV may administer after 4hrs .

Torsade de pointes:1-2g Slow IV over 5-60min then 0.5 -1g/hr IV

Cardiac arrest:1-2g slow IV over 5-20minutes.

Preterm labor:Used as a tocolytic Loading dose:4-6g IV over 20minutes, Maintenance:2-4g/hr for 12-24hrs.

Eclampsia :Intially 1-2g in 25%-50% is given IM over 30minutes

c)Adverse effect of magnesium sulfate:

• Cardiovascular:Vasodilation,Hypotension
• Hematological:Prolonged bleeding
• Respiratory:Respiratory tract paralysis.
• Musculoskeletal: Hypoflexia
• Neurological:CNS depression,Stupor

d)Nursing responsibilities for safe administration of Magnesium sulfate:

• Use caution with renal impairment.
• Monitor ECG and respiratory status.
• Product contains aluminum therefore increasing risk of aluminum toxicity.
• Magnesium toxicity results in respiratory depress and loss tendon reflexes.
• Monitor Magnesium level.
• Calcium gluconate is the antidote.