Reference no: EM133914047
Case Study 1. CR is a 24-year-old G3 P1-0-1-1; 5 feet tall and weighs 142 lbs. at 42 weeks gestation. Prepregnant weight was 125 lbs. It is now 0100 and the patient has been in active labor for 16 hours. The patient is 6cm, 100%, and vertex at -2 station. Two hours later (0300) the vaginal exam remains the same with contractions q 5-6 minutes, lasting 45-60 seconds, palpate strong; FHR is 136 with moderate variability and accelerations, no decelerations are noted. Estimated fetal weight by palpation is 7 ½ - 8 lbs. Patient's last baby weighted 7 lbs. 6 oz. and was born vaginally without difficulties. Patient is GBS positive and is receiving 1 gm of ampicillin IV every 6 hours. Due to lack of progress the provider orders a Pitocin IV drip to start at 4 mu/min and increase every 20 minutes by 2 mu/min until contractions are 2-3 minutes apart lasting 50-60 seconds. Membranes are ruptured artificially, fluid is clear, an internal fetal scalp electrode (FSE) and internal uterine pressure catheter (IUPC) have been inserted.
Two hours later (0500) contractions are q 2 minutes, lasting 60 seconds, and the IUPC shows they are strong. FHR is 150, no accelerations, minimal variability, and no decelerations. Patient's vitals are BP - 120/72, HR 82, RR 16, T - 99.1° F. Vaginal exam: 8cm, 100%, -2 station. Patient now has an epidural in place as well as a Foley catheter.
What is the significance of the last vaginal exam?
CR becomes fully dilated at 0600, pushes for 2 hours. When the head delivers it "turtles". What does this mean (2 pts) and what actions need to be taken? Name at least 5.
What is the correct way for suprapubic pressure to be given?
What positions can the patient assume to help deliver this baby? Name at least 3.
What possible injuries might the baby sustain? Name at least 5.
What possible injuries and complications can the patient sustain? Name at least 5.
Case Study 2. CC is a newborn infant. There were no problems during the pregnancy or during the labor and birth. Infant is 39 weeks gestation and was born via a nonmedicated, spontaneous vaginal birth. The nurse responsible for the newborn is at the birth.
Starting from the birth, list the care the nurse will provide for the infant during the first hour. Be specific!
CC and parents are due to be discharged today. What patient education should the nurse make sure the parents get before leaving the hospital? Be specific.
There are some routine screening tests that are done on newborns before discharge. Name at least 2, how they are done and what they are for.