You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action, that is, whether to do a vaginal exam or to continue asking her more questions.
What three initial questions will you ask, and why?
D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy
(gravida 3, para 2002). Her bag of waters is intact at this time. She states that her due date is 2
days away. You determine that it is appropriate to ask for further information before a vaginal
exam is done. What information do you need?
What assessment should you make to gain further information from D.H.?
Upon examination, D.H. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is
150 beats/min and regular. She is admitted to a labor and delivery room on the unit. What
nursing measures should be done at this time?
List the stages of labor. D.H. is in what stage of labor?
D.H. states that she is feeling discomfort and asks you whether there is alternative therapy
available before taking medication. List at least four alternative methods to assist D.H. with
controlling her discomfort.
As you assess both the mother and the fetus during the active stage of labor, you will look
for abnormalities. Which of these are potential abnormalities during labor? (Select all that
apply.)
Unusual bleeding
Brown or greenish amniotic fluid
Contractions that last 40 to 70 seconds
Sudden, severe pain
Increased maternal fatigue
11 Maternal/ObstetricCASE STUDY PROGRESS
Although D.H. continues to use alternative therapies for discomfort, she asks for pain medication and receives a dose of meperidine (Demerol). Three hours later, D.H. is lying on her back, and during contractions you notice a few late decelerations of the FHR. You stay with D.H. to monitor her and her fetus and immediately call for someone to notify the PCP.
Put these actions in order of priority accompanied with an explanation to why you chose that particular order.
Discontinue the oxytocin infusion.
Turn D.H. onto her left side and elevate her legs.
Increase the rate of the maintenance IV fluids.
Administer oxygen at 8-10 L/min by facemask.
Decelerations occur in an early, variable, or late pattern. What is the significance of these
patterns? State what the nurse should do for each type.
As you monitor D.H., you observe for prolapse of the umbilical cord. Describe what this is
and what can happen to the fetus if this occurs.
What would be done if you noted that D.H. had a prolapsed cord?
The decelerations stop, and the remainder of the labor is uneventful; D.H. has an episiotomy to allow
more room for the infant to emerge and delivers a male infant.
What is involved in the immediate care of the newborn?
As you assess the newborn, you observe for CNS depressant effects that might result because the mother received an opioid during labor. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects in the newborn, but when is naloxone contraindicated for an infant?
D.H. has her episiotomy repaired and the placenta delivered. What are the signs that the
placenta has released from the uterine wall?
What assessments are important for D.H. following delivery?
CASE STUDY OUTCOME
FINAL OUTCOME: D.H. and her newborn baby boy are taken to the maternity unit where she begins to breastfeed him
