Question

Case Studies

Essentials of Maternity, Newborn, and Women's Health Nursing

Chapter 13: Labor and Birth Process

1. Emily, age 32, has an obstetrical history of G1, T0, P0, A0, L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.

The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.

Ten minutes after the vaginal exam by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)

What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?

Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? Why?

Describe the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants.”

2. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)

Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.

What strategies may the nurse implement to assist Diane in progressing in her labor?

Answer 1

A)Emily's case:Nurse should ask the emily about signs of true labour.this will help her to understand whether she is in true or false labour.

1)ask about contractions.if it is strong regular it is the sign of true labour.

2)if she tell that her water breaks.ask about color of fluid to know the color provide strike pad inorder to understand the presence of amniotic fluid.

3)lower back pain and cramping

4)bloody vaginal discharge

5)sometimes nausea and vomiting

if these signs are reported by the patient nurse can confirm she is in true labour

Prenatal history::

1) prenatal history includes :::::::::::

personel history:allergies,illness occurred as a child,previous medical conditions,chronic illness,hospital stays,

surgical history:previous history of minor or major surgery,complications,anesthesia history,

medical history::previously taking medication,current medication,vaccinations

Lifestyle history:drug or alcohol abuse,vegetarian or non vegetarian,weight loss or gain

previous pregnancy:term pregnancy,abortion,multiple pregnancy,live children

menstrual and gynaecological history:dysmenorrhea,regular or irregular periods,blood flow,STD

current pregnancy history:LMP,cramping,bleeding,vaginal discharge,investigations done,group Rh of patient

nurse findings indicate patient is in first stage of labour cervix is started get dilated and effaced.her cervix is dilated 3 cm which shows she is in latent phase.in this phase uterine contractions occur every 15 To 30 mnth and last for 15 To 30 seconds.In this phase encourage mother to participate in care.assist with comfort measures.

Cervix dikatation will occur .abdominal becomes tight due to the uterine contractions.myometrial tone of uterus must change to allow coordinated contractions.mother becomes anxious and restless as contractions becomes stronger.be with the patient.encourage to take effective breathing patterns,provide quite environment,allow the family members to visit if she wants there presence.these support should be given to the patient to cope with physical and psychological stress.

positions :supine,semi-recumbent,sitting,walking ,standing,kneeling or squatting position can be given to the patient in first stage

studies says that supine position in labour may have physiological effect on the condition of mother and baby .and also help in the progression of labour.postions should be changed frequently to ease the blood flow to the placenta.while walking she can increase her sense of control in labour by providing self distraction from challenges of labour.while,recumbent positions help the care providers to palate mothers abdomen to monitor contractions,check the position of the baby and vaginal examination.moreover,Fortaleza heart sound is easily audiable inthis postion

Interventions:when patient says that her membranes breaks, color of aminiotic fluid is checked because meconium stain fluid can indicate fetal distress

If fluid is clear check the heart rate of the baby and progress of labour to prevent the complications

administer antibiotics according to doctors order to prevent infection

B)Diane case::5 p's1)powers:uterine contractions

2)passage way-mothers pelvis,cervix,pelvic floor,vagina and introitus are the passage ways

3)passenger-fortis,membrane and placenta

4)psyche-mother total response to labour .how her emotions controlled or not.she may have anxiety or fear.

Cardinal movement of labour::::::

1)engagement

2)descent

3)flexion

4)internal rotation

5)extension

6)external rotation

7)expulsion

uetrine contactions can cause both regular and back labour contractions.baby is lying in sunny side up position with back labour contractions.which means baby's head is little down by her cervix and it faces her stomach instead of your back .this may lead to sever back pain during labour.

her progression get slower due to the slow effacement of cervix.sometimes slow progress it can be related to psychological factors such as stress, fear ,or worry

strategies to improve progress:::

1)amniotomy

2)intravenous oxytocin

3)psychological support to minimize the risk