Question

maternal health case study

A 42 y.o. G2P1 pt arrives to L&D at 41 weeks, c/o contractions and leaking fluid. Pt has hx of Gestational Diabetes Mellitus (GDM) with her last pregnancy, with a normal spontaneous vaginal delivery (NSVD) of viable female who weighed 10 lbs 5 oz. Pt stated she had "problems" with the delivery and states "they had a hard time getting her out". Pt also has GDM this pregnancy, diet controlled, but admits on admission she "wasn't real great about following the diet". Admission glucose was 110 mg/dL, and all other labs WNL. FHT's are WNL, contractions are noted every 2-5 minutes, pt is 4-5 cm dilated and grossly ruptured. What is pertinent information to share with the provider when obtaining admission orders?? What would your main concerns be about caring for her during delivery? What risk factors does this patient have for a complicated delivery? The pt gets an epidural, progresses normally, and the provider is called for delivery. After delivery of the head, the provider states he is having trouble delivering the shoulders. What is the complication called? List at least 3 priority nursing interventions and at least 2 medical interventions for this Obstetrical emergency. List at least 2 possible negative outcomes for this neonate resulting from this complication.

Answer 1

Pertinent information to share with the provider when obtaining an admission order is the patient history of complicated delivery due to excess baby weight. stabilize her blood glucose and blood pressure level during delivery and watch for complications.
risk factors include age above 40 years, gestational diabetes, baby weight more than 10 pounds.
The complication is called shoulder dystocia
3 nursing interventions:
-get help for delivery the baby
-Pull the patient leg towards to abdomen to flatten and rotate the shoulder, this is called Mc Robert maneuver.
- Provider suprapubic pressure for the shoulder to rotate.
2 medical interventions:
-Episiotomy for the opening the birth canal
-Use maneuvers or internal rotation technique to move the shoulder
2 negative outcomes:
-Brachial plexus injury
=Brain damage and death due to insufficient o2