Reference no: EM133857379

Assignment:

Catherine is a 14 year old, G1P0, single Black American teenager. She is admitted to the labor suite in active labor at labor at 41 wga. Her pregnancy has been normal. She gained 28 pounds during the pregnancy. Her pelvis is gynecoid.

Case Study

Catherine's admission exam reveals the cervix 100% effaced, 6 cm dilated, and the baby at -1 station; membranes are intact. Her contractions are every 5 to 6 minutes, moderate to strong, and lasting 1 minute. The FHT are 130s with good long-term variability (LTV) and occasional accelerations. Uterine relaxation is palpated between contractions. Catherine is tolerating the labor very well. At home she was walking around and dancing to relieve the contractions. She also finds that either singing or moaning with the contractions is a good distraction for her. She is in good spirits and pleased when she hears that she is already 6 cm. Her girlfriend, who also has a baby, is her coach; and they giggle between contractions. She brought her CD player to the hospital so that she could continue to play her music and dance. She has found that by rolling her hips with the dancing it gives her a lot of relief with contraction pain. She has been having serious contractions for about seven hours. At home she ate a small amount of food and drank large amounts of juice, Gatorade, and water. Her pregnancy has been normal. Her admission vital signs are BP 128/68 (elevation in her systolic over her usual 110) pulse 84, respirations 20, and temperature 98.6.

1. Identify the coping mechanisms that Catherine is using and describe how they work.

2. Since her contractions are only moderate to strong and coming every 5 to 6 minutes, the obstetrician wants her to have Pitocin to increase their strength. Catherine refuses. Discuss the pros and cons of this order and the consequences of Catherine's refusal. She also refused the routine IV. Catherine's mother insists that she have the IV and she relents, crying.

3. Catherine's friend opens a lunch thermos and hands Catherine a cup of Gatorade to drink. The labor room standing orders are NPO in active labor. What is the rational for the NPO orders, and how might the nurse handle this situation?

4. Two hours after admission Catherine's contractions are 8 to 10 minutes apart. A vaginal exam indicates little change in her progress. What are the possible reasons for this?

5. The obstetrician decided to rupture her membranes during the vaginal exam to speed things along. The fluid is clear. She tells Catherine that she will have to have the Pitocin now because, if she does not resume labor and dilate, she may get an infection and endanger herself and the baby. The Pitocin is started. Catherine is in bed on an external monitor and beginning to feel very strong contractions. 20 minutes after Pitocin is started the contractions are so strong that Catherine is crying and asking for something for pain. The FHTs are 130s with no accelerations and minimal long-term variability (LTV). A decision is made to insert a fetal scalp electrode to do internal monitoring. Contractions are every two minutes, lasting 90 seconds, and strong. Should the decision to rupture the membranes have been Catherine's?

6. How does it alter Catherine's labor?

7. What is the significance of the change in the FHT pattern?

8. What pain medication option might be available to Catherine? List the advantages and disadvantages of each.

9. Catherine's baby's heart rate decelerates to 100 bpm, then quickly rises to 150 bpm for 15 seconds, and then returns to the baseline of 130s. This happens three times in 10 minutes. What is the possible cause of this?

10. What nursing actions are necessary?

11. The doctor orders an aminioinfusion. What is this procedure, and why has he ordered it?

12. What are the nursing responsibilities when aminioinfusion is ordered?

13. Catherine is given 800 mL IV of LR in preparation for an epidural. What is the rational for order?

14. Identify three nursing diagnoses that are appropriate for Catherine's care.

15. What the potential effects of the epidural on Catherine's baby?