Question

Instructions All questions apply to this case study. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Scenario 2 You are the charge nurse working in labor and delivery at a local hospital. D.H. 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 her three initial questions to determine your next course of action, this, whether to do a vaginal exam or to continue asking her more question. 1. What three initial questions will you ask, and why? 2. D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her bag of waters is intact at this time. She states that her due date is 2 days away. You determine that it is appropriate to ask for further questions before a vaginal exam is done. What information do you need? 3. What assessment should you make to gain further information from D.H.? 4. Upon examination, D.H. 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. What nursing measures should be done at this time? 5. List the stages of labor. D.H. is in what stage of labor? 6. D.H. states that she is feeling discomfort and asks you whether there is alternative therapy available before taking medication. List at least four alternative methods to assist D.H. with controlling her discomfort. As you assess both the mother and the fetus during the active stage of 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 8. Put these actions in order of priority: _a. Discontinue the oxytocin infusion. b. Turn D.H. onto her left side and elevate her legs. c. Increase the rate of the maintenance IV fluids. d. Administer oxygen at 8-10 L/min by facemask. 9. Decelerations occur in an early, variable, or late pattern. What is the significance of these patterns? State what the nurse should do for each type. 10. As you monitor D.H., you observe for prolapse of the umbilical cord. Describe what this is and what can happen to the fetus if this occurs. 11. What would be done if you noted that D.H. had a prolapsed cord? 12. What is involved in the immediate care of the newborn?

Answer 1

9. Correct ans. Significant of theses pattern are contraction stress test used for mother to administer oxytocin to assess fetal well being.

Oxytocin administer to mother 1 mu/minutes then change the fetal heart rate that's are deceleration are three types:-

1. Early deceleration :- compression of fetal head by pelvis

Condition- labour time

2. Late deceleration :- indicated utero placental insufficiency, so administer oxytocin

3. Variable deceleration :- cord compression, so change the position

No late deceleration and no significant variable deceleration :- indicated fetal well being.