QuestionAnswered step-by-stepPATIENT INFORMATION Name: Mrs. T D.O.B 3/31/1983 MR # 1234567 Room:…PATIENT INFORMATION Name: Mrs. T D.O.B 3/31/1983 MR # 1234567 Room: 5006 Gender: Female Age: 35 Race: Caucasian Weight: 124 lbs Height: 5’2 inchesCode Status: Full code Chief Complaint:R/O Labor OB Provider: Dr. Malcolm X Allergies: Strawberries-Hives OBSTETRIC HISTORY Pregnancies1996-NSVD, Girl, 7 lbs, 6 oz, delivered at 38 weeks gestation2001-NSVD, Spontaneous abortion at 8 weeks gestation2011-NSVD, Boy, 9 lbs 12 oz, delivered at 39 weeks gestation LNMP: October 13th 2017 Age of Menarche:13 yrs old Estimated Date of Delivery: July 20th 2018 # Of Prenatal Care Visits: 9 Medical HistoryHyperlipidemia Surgical HistoryAppendectomy Family HistoryMother- Type 2 diabetesFather- Hypertension/ Hyperlipidemia Medications:Iron Deficiency Anemia- Ferrous Sulfate 50 mg PO Daily Current Obstetric Complications:Gestational Diabetes- Diet controlledChlamydia & Gonorrhea-Positive, treated with azithromycin Social History:Married, Spouse at bedside Drug Use: NoneAlcohol Use: None ImmunizationsTDap & Flu shot givenRhoGam given at 24 weeks LABORATORY RESULTS Hepatitis B Rubella RPR HIV ABO RH Hemoglobin Chlamydia & Gonorrhea GBBSNegative Non-Immune Non-Reactive Negative A Negative 9 gd/dl Positive Positive Mrs. T. presents to OB triage unit reporting “on and off” contractions all day. Her contractions are starting to increase in frequency and intensity. They are 5 minutes apart, lasting for at least 1 minute for the past hour. She denies leaking of fluids. She had a slightly elevated blood pressure ranging from 134/84 -136/86 during her last few visits and has been closely monitored. Her last urine dipstick test shows no protein in her urine. She has been feeling lightheaded, & experiencing mild headaches. Is Mrs. T. experiencing true or false labor? What is the difference between true and false labor? In triage, the nurse asked Mrs. T. to leave a urine sample and liein bed. The LPN takes her vital signs and documents T- 98.9, F P-93, R-18, B/P 145/88 Are Mrs. T.’s vital signs normal? If not, what would you be concerned about? The nurse performs a urine dipstick and the results shows +2 for proteins and ketones.The nurse notifies the midwife. The midwife suspect Mrs. T. has preeclampsia and orders further testing. What is Preeclampsia? What signs and symptoms indicate that Mrs. T. may have preeclampsia? What are complications of preeclampsia? Mrs. T. needs to go to the restroom again. When she returns she repositions the bed to a flat position and lies down flat on her back. Is Mrs. T. position appropriate? If not what interventions would you perform & why? The nurse repositions Mrs. T. comfortably and performs Leopold maneuver before applying the toco transducer and external fetal monitor to determine fetal heart rate and frequency of uterine contractions. What is Leopold maneuver? What are the normal heart rate ranges? What does acceleration mean? What is variability? What does frequency of contractions mean? What does the duration of the contraction mean? Suddenly, Mrs. T. yells out “I think my water just broke, I feel a gush!”. The nurse notices clear fluid, on the chux pad with no odor. The nurse calls the provider to come and evaluates Mrs. T. List the characteristics of normal/abnormal amniotic fluid. What nursing interventions are important to monitor after the rupture of membrane? The midwife comes in the room, introduces herself and performs a sterile vaginal exam. The midwife tells the nurse she is 3/50/-2. The provider obtains a nitrazine swab sample of fluid and the swab turns blue. The midwife informs Mrs. T. that the labs confirm she has mild preeclampsia. The midwife monitors her blood pressure and determines if she needs to be placed on magnesium sulfate. What does it mean when the nitrazine swab turns blue? What tests are performed to determine positive SROM? Based on the exam, Mrs. T. is in what stage of labor? What type of teaching can the nurse provide for Mrs. T. at this time? Mrs. T. is admitted and transferred to a labor room via wheelchair since the provider confirms her bag of waters has spontaneously ruptured. The nurse asks the patient if she needs to go to the bathroom. Mrs. T. heads to the bathroom and returns back and in bed. The nurse begins to do Mrs. T’s admission paper work, she reviews her chart and asks Mrs. T. questions regarding her medical and obstetrical history. She reviews her laboratory results which show that she is GBBS positive. She will need to give Mrs. T. antibiotics. Why is it important that Mrs. T. empty her bladder frequently during labor? Mrs. T. is GBBS positive. Why do we administer antibiotics? Several hours later, Mrs. T. appears more uncomfortable during contractions. Her husband arrives and is comforting her. She hasn’t been able to get any sleep. The midwife comes in to check on Mrs. T. She wants to evaluate her progress and performs a sterile vaginal exam again. The midwife reports to the nurse, she is 6/75/+1. The baby is in an OP position. Mrs. T. appears to be very uncomfortable and in pain. The nurse asked if she is in pain and patient states, “Yes, I am.” The nurse asks her to rate her pain on a 0-10 pain scale and describe her pain and location. Pt states, “my pain is 8/10, I feel lots of tightening & cramping in my abdomen from the contractions and severe lower back pain”. The nurse asks Mrs. T., if she would like anything for pain? She says “No, I really want to try to have a natural delivery, what can I do about this lower back pain”. Describe the findings of the vaginal exam. Mrs. T. is in which stage/phase of labor? What is an OP position? What does it indicate? What comfort measures can the nurse provide for Mrs. T.? What types of non-pharmacological measures can help Mrs. T. facilitate a natural delivery? (Describe 3 types) The nurse develops a plan of care. What would be appropriate nursing goals and interventions to do at this time? Provide 1nursing diagnosis, Goal, 3 interventions with rationales Nursing Diagnosis Patient Goal and Outcome criteria 3 interventions The nurse coaches Mr. T. on different types of positions to make Mrs. T. comfortable while she is laboring. Why is changing position during labor important? After several hours later, Mrs. T. progresses to 9/100/+3. She is restless and can’t take the pain anymore after changing into several different positions. She asks the nurse “I would really like something for pain now.” I heard about a medication called Nubain that can be given for pain during labor. Is it possible that I can get that?”. What type of pharmacological method is Nubain and how does it work? What stage of labor is Mrs. T. at? Is Mrs. T.’s behavior normal and why? The nurse informs the patient that she is too close to deliver and she would not be able to administer Nubain and explains to her why. Why is Nubain not administered too close to delivery? The nurse has the patient lean on the birthing ball and while the husband provides counter pressure on her hips to ease her back pain. The nurse and Mrs. T.’s husband continue to support Mrs. T. and provide encouragement. Suddenly, She says she needs to go to the bathroom; she feel like she needs to have a bowel movement. What do you think the nurse should do? Should the nurse get Mrs. T. up to go to the bathroom? Explain The nurse explains to the patient what is happening. The nurse calls the midwife to come in & check the patient. Mrs. T. is 10/100/+4. The nurse takes Mrs. T. vitals T:100, P:106, R: 20, B/P 144/88. She notifies the midwife and decides to order magnesium sulfate and nifedipine. She is concerned that Mrs. T.’s temperature is elevated and she is tachycardic. It appears that Mrs. T. developed chorioamniontis. What does Mrs. T.’s vaginal exam indicate? What stage of labor is Mrs. T. in? What is next stage the nurse will prepare for? Why is magnesium given? What are nursing considerations when administering magnesium sulfate? What should the nurse monitor when administering this medication & why? Why is nifedipine given? What is chorioamniontis? After 30 minutes later, Mrs. T. is in the second stage of labor. She has been in hand and knee position to help with back labor. She has been pushing for two hours and is very tired. She is having difficulty pushing the baby since the baby appears to be too large. The provider decides to perform a midline episiotomy and uses a vacuum assisted device to deliver the baby. She delivers a healthy baby girl at 1:55 am. The quantitative blood loss (QBL) is 600 mL, she has a midline episiotomy with repair. The midwife asks the nurse to start pitocin as the placenta is about to be delivered. The nurse administers 20 units of pitocin in lactated ringers and infuses at 125mL/hr IV. After delivery of placenta, the fundus is firm at umbilicus, with moderate amount of lochia. Mrs. T. voids 700 mL of urine. The nurse instructs the patient about the importance of pericare. The nurse continues to monitor Mrs. T.’s blood pressure. Her blood pressure is stable. What is a vacuum assisted delivery? What is an episiotomy? Based on Mrs. T.’s delivery and history, what is Mrs. T. at risk for and why? What is pitocin IV? Why is pitocin administered after delivery? The midwife places the baby on Mrs. T. chest and the nurse dries off the baby and removes the wet linen. The nurse initiates skin-to-skin contact. Mrs. T. and her husband are overjoyed to finally meet their daughter. What is skin-to-skin? Explain skin-to-skin benefits for both mother and baby Mrs. T. is doing skin-to-skin & bonding with her newborn baby the first ½ hour after delivery. While, Mrs. T and her husband bond with their baby the nurse will assist the midwife in delivering the placenta and suturing Mrs. T.’s episiotomy. She will also perform her assessment on the baby and continue monitor Mrs. T.’s recovery until she is ready to be transferred to postpartum unit. Health ScienceScienceNursingNURSING 211Share Question