Question

L&D Scenario

At 0830 hrs. - Leanne arrived by car to your unit, with her husband George and her mother Catherine. She states the membranes ruptured at 0800 hrs and is feeling uncomfortable

With contractions that started at 0500 hrs.

She is G1 P0 A0, Her LMP was April 2nd 2019. The Ultrasound and dates confirmed her.

EDD to be January 9th; making her 40+1 today.

Leanne last ate at 1800 hrs the night before and has been drinking clear fluids this morning.

Her blood group is A positive.

She is a healthy woman and has had a healthy pregnancy; taking vitamins only. Leanne plans to breastfeed.

Leanne has no allergies and has not been in contact with communicable diseases or had any recent hospitalization. GBS, HBsAG, HSV negative.

Leanne is having regular q 2-3 minute (3-4/10min) contractions that are strong on palpation with the uterus relaxing between. Her pad reveals clear amniotic fluid with scant mucous show.

Leanne states the baby has been moving; that she feels supported the way she is managing her labor even though the pain is intense. She describes her pain as a "6" on the pain scale.

She has been admitted directly to a birthing room.

0845 hrs - you perform a physical assessment -- Leopold's Maneuvers reveal a vertex

Presentation; Fundal Height 37cm; longitudinal lie, position LOA and the EFW 3600 gms. The FHR was 144 bpm .

The vaginal exam revealed a fully effaced cervix, 8cm dilated, station +1.

BP 110/70 Pulse 100 bpm and Respirations 24 Temperature 37.4C Urine Nil for protein and ketones.

After 2hrs she have regular q 2-3 minute (4-5/10min) contractions that are strong on palpation with the uterus relaxing between , with vaginal examination cervix, was 9cm dilated.

Vital signs are BP 115/75, p. 92 Respirations 24 Temperature 37C.

Questions:

- How can you help her to relax during her contractions? (1)

- Describe which stage and phase she is ? (1)

- When you assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall? (1)

- Which measure would be effective in preventing postpartum hemorrhage? (1)

-Do the Partogram for your patient? (1)

- Develop nursing care plan ? (3)

Answer 1

1. Relaxing inbetween contraction is very important because blood flow from the mother into the placenta gradually decreases during contractions. During the interval between contractions, the placenta refills with oxygenated blood for the fetus. This can be done by :-

- massaging or rubbing the lower back

- deep breathing

- providing emotional support

- use of a hot pack on the lower back .

2. The patient is in first stage of labour. It is beginning of regular contractions or rupture of membranes to 10cm cervical dilation.

The patient is in transition phase.

It begins at 8cm and ends at 10cm

Transition phase :-

short but intense phase, increase in bloody show, may have urge to push, n&v are common, irritability, afraid to be alone.

3. Change in uterine shape indicates that the placenta has separated from the uterine wall.

4.