Case study: Contractions.

1. Marvis is a 29-year-old G1P0 in labor at 40 weeks of gestation. She was admitted at 0200 with a history of contractions since 2200 the night before. Upon admission she denied spontaneous rupture of membranes or vaginal bleeding. She felt good fetal movement. Her vital signs and the fetal heart rate were normal. Her contractions were every 6 minutes and lasting 30 seconds. Her cervical exam was 2 cm/ 70%/?2 vertex. It is now 0600, and she has been reexamined. Her cervical exam is now 3 cm/90%/ ?2 vertex. Her contractions are now every 4 to 5 minutes lasting 60 seconds. She states they are still mild. Marvis has stated that she wants a natural un medicated birth.

a. In what stage of labor is Marvis? What is the Rationale? In other words why do you think she is in this stage?

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b. Marvis expresses disappointment in her progress. What can the nurse do to help her at this point in her labor? What is your Rationale for choosing these interventions?

c. It is now 1000 and Marvis states the contractions have become much stronger. She now needs to utilize breathing techniques to cope with the contractions. She declines pain medication. Her cervical exam is now 5 cm /100%/0 station. In what stage of labor is Marvis at this time? What is the Rationale? In other words why do you think she is in this stage?

d. What nursing care is indicated at this phase of labor? What is your Rationale?

e. Marvis is now perspiring profusely and shaky. She feels she can’t cope any longer. She pushes away her husband as he tries to rub her back. An increased amount of bloody show is present. She also reports a gush of fluid. Even without a cervical exam, what phase of labor is Marvis most likely in? How would you expect Mavis to behave at this stage?

2. Giselle is a 30-year-old G1 P0 admitted at 39 weeks of gestation in early active labor. Her cervical exam is 3 cm/100%/?1 vertex. Her membranes are intact. Her contractions are every 4 minutes × 60 seconds. Fetal heart tones are 140 with moderate variability, accelerations present, and no decelerations. She declines medication for pain at this time, but states she might want something later. Her partner is at the bedside and appears anxious.

a. How can the nurse help Giselle cope with the pain of contractions at this time in labor? Give Rationale for your interventions.

b. Four hours later Giselle’s contractions are every 3 minutes and much stronger. Her cervix is now 6 cm/100%/0 station. She is requesting medication for pain but is not sure if she wants an epidural or IV pain medication. How can the nurse counsel her regarding her choices?

c. Giselle decides to use IV pain medication and the nurse-midwife orders 2 g of Butorphanol IV. What should the nurse do to safely manage the administration of the medication and the subsequent care of the patient? Think normal responses to pain medication.

d. Giselle suddenly feels an urge to push and experiences spontaneous rupture of membranes 1 hour after administration of the Butorphanol. The nurse midwife examines Giselle and finds her to be completely dilated with the vertex at +2 station. What should the nurse anticipate? What preparations and plans should be made?

3. Julian is a healthy stable newborn at 5 minutes of life. He is on his mother’s abdomen while she and his father are admiring him.

a. How can the nurse promote patient safety for Julian at this time? Please describe your plan in detail with rationale.

b. Julian is now 45 minutes old. He has stayed in his mother’s arms and she has already breastfed him successfully. His mother now gives him to the nurse in the delivery room who brings him to the infant warmer while the mother is eating a snack. What can the nurse do at this point to promote Julian’s patient safety? Rationale?

c. Julian is now 2 hours old. He and his parents are being transferred to the mother-baby unit where they will remain until discharge in 1 or 2 days. What can the nurse do to promote patient safety for Julian at this time? Rationale?

d. 4. Julian is now ready for hospital discharge at 36 hours of age. His parents, although exhausted, are happy to be bringing him home. What can the nurse do at this time to ensure Julian’s safety? Rationale

4. Charlotte is a 27-year-old G1P1 who just gave birth to a healthy female infant at 39 weeks of gestation. The baby is now 20 minutes of age and has transitioned well. Charlotte wants to breastfeed her infant because she has read about the benefits of breastfeeding. Her mother and sisters who are present have not breastfed and are not convinced of any benefit because their children were also healthy. The father of the baby is not involved.

a. What can the nurse do now to help Charlotte succeed in breastfeeding? Rationale?

b. Charlotte’s mother comments that she doesn’t think the baby got enough to eat from the first breastfeeding attempt. Charlotte agrees and feels that she doesn’t have any milk yet. The baby latched on to both nipples well and sucked effectively for 15 minutes on each side. The infant now is crying, and Charlotte’s mother requests a bottle of formula. How can the nurse address this situation? Rationale?

c. It is now day 2 after birth and Charlotte is complaining of sore nipples. How should the nurse evaluate this complaint? How can the nurse help Charlotte? Rationale?

d. What additional nursing interventions may be helpful for Charlotte before hospital discharge? Rationale?

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