Maternal Newborn Scenarios Renee Wilson

 Renee Wilson 26 y/o G1P0 admitted four hours ago to the Birthing Center. She has had an uncomplicated pregnancy, but her obstetrician has expressed the concern about needing a c-section because of the anticipation of a large baby. Her last ultrasound estimated fetal weight at 9 lbs. 6 oz. She and her husband have attended Lamaze Prepared Childbirth Classes and their Birth Plan includes the desire to have an unmedicated labor and vaginal birth. She also desires skin to skin contact with her baby at birth and breastfeeding. Admit assessment findings: Sterile vaginal exam (SVE) - 4 cm, 80% effaced, and fetal vertex at a -2 station with intact membranes, slight bloody show. BP 110/70 mmHg, P. 88 beats/minute, R 24 breaths/minute; T 98.8 F. 37.1 C. FHR 150 baseline with moderate variability + accelerations, absent decelerations (Category 1). Contractions are occurring every 2 minutes, lasting 60 seconds with moderate intensity per palpation. Portable tocodynamometer and fetal ultrasound transducer are in place. She is using shallow-chest breathing and conscious relaxation techniques and is ambulating in her room. She rates her pain at 5/10. She tells you that she will feel like a failure if she can’t deliver vaginally. You correctly diagnosed13out of13options: Physiological Description Acute Pain Anxiety Bleeding Imapired mobility Impaired patterns of elimination Infection, Risk for Nausea Safety Your Response Expla True Status assessment reports frequent contraction pain 5/10. True Status assessment reports potential for caesare unmedicated vaginal birth. False Status assessment indicates just a slight bloody False Status assessment reports woman ambulating delivery. True Status assessment indicates active labor which True False Description Deficient Knowledge Fall, Risk for Impaired maternal newborn bonding, Risk for Risk for fetal injury Risk for Ineffective Coping Risk for Situational Self Esteem Status assessment reports a large fetus with po Status assessment does not indicate increased Your Response Exp True Status report indicates attendance at child variety of coping skills and education. True Status assessment reports woman ambula labor may increase for falls. True Status assessment reports potential for an maternal failure. True Status assessment reports fetus at -2 stati contractions. True Risk assessment reports minimal family su True Status assessment reports potential feelin Renee WilsonScenario1 You enter the patient’s room. After washing and gloving hands, you identify yourself and the patient, Mrs. Renee Wilson. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step 1 1 Discuss C-Section as an alternative method of childbirth. 2 2 Allow the woman to verbalize feelings and thoughts regarding potential for C-section. 3 3 Praise woman and husband for efforts in use of non-pharmacologic labor techniques. 4 4 Encourage frequent position changes and hydrotherapy in shower. 5 5 Suggest changing to a more complex breathing technique since pain is rated at 5/10. Allays fear of being delivery is conside Can be used to foc Boosts self-esteem Comfort and relaxa Requires increased more painful stimu Renee WilsonScenario2 Two hours later contractions continue at every 2 minutes, lasting 60 seconds, and she states they “feel about the same”. She is sitting in the rocking chair and states that she feels like she may be leaking fluid. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step 1 1 Assist woman to bed; reassess FHR baseline and reactivity. 2 2 3 3 4 4 5 5 Spontaneous rupture of m prolapsed cord; indicates critical. Using a sterile gloved hand, test fluid leaking Nitrazine paper different from vagina with Nitrazine paper. from urine (acidic). Need Assess color and character of amniotic fluid. Amniotic fluid should be indicative of potential alt Assess contraction pattern and palpate Assess labor progress an uterine resting tone. Reassess maternal vital signs, including Monitors physiological re temperature; assess temperature every two hours. Renee WilsonScenario3 Oxytocin augmentation was ordered by the healthcare provider and begun at 2 mu/min, with an order to increase by 1-2 mu/min every 30 minutes based on the response of the woman and fetus and progress of labor. Mrs. Wilson has been laboring for 8 hours now and is 6 cm, 80%, but still at a -2 station. Vital signs are stable; T 98.8oF, FHR remains a Category 1 with baseline at 150 bpm, moderate variability and + accelerations. Mrs. Wilson is complaining of back pain and tells you she is getting tired and asks for advice on coping. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step 1 1 Reassess maternal and fetal status every 15 minutes and with each dose change of oxytocin. 2 2 Encourage her to void at least every two hours, assessing intake and output. 3 3 Assist her with peri-care and change underpads as needed. 4 4 Teach husband how to apply counter-pressure to woman’s back during contractions while sitting on birthing ball. 5 5 Continue to provide comfort measures and minimize distractions in room. To determine contra rate; FHR must be r Avoid bladder diste comfort. Provides comfort an Relieves back pain t position; encourage encourage fetal des Decrease discomfor techniques. Renee WilsonScenario4 Four hours later the oxytocin is infusing at 18 mu/min. Contractions are every 2 minutes, lasting 60 seconds and moderate intensity per palpation. FHR baseline has increased to 170 bpm with minimal baseline variability (Category II). Sterile vaginal exam conducted by healthcare provider reveals no change from earlier exam: 6cm, -2 station. An emergency C-Section is called. Operative consent is on chart; operating room team assembled, including the Neonatal Nurse Practitioner (NNP) to care for infant. Mrs. Wilson and her husband are quickly educated on what to expect during CSection. She is transferred to the OR per stretcher accompanied by her husband. Following administration of a spinal anesthetic she is placed in a supine position with slight left lateral tilt. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your orde Correc r t order Step 1 1 Assess FHR before removing transducer; cleanse abdomen with chlorhexidine wipes. 2 2 3 3 4 4 5 5 Explanation Document fetal status prior to beginning surgical delivery; kills bacteria on skin that can cause infection. Insert Foley catheter. Keeps bladder empty to prevent damage during operative delivery. Apply sequential Prevents blood clot compression device formation; ensures (SCD) boots to calves; safety and proper secure legs to OR table positioning. with strap. Perform lap, needle and Establishes baseline instrument count with count to ensure nothing OR tech prior to start of is left inside patient. case and at established intervals. Perform Time-Out. Confirms patient identity, procedure performed, and presence of appropriate Your orde Correc r t order Step Explanation personnel. Renee WilsonScenario5 Infant is delivered through a low transverse incision and handed to the Neonatal Nurse Practitioner (NNP). SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correct order order Step 1 1 Assist in drying infant and place on a pre-warmed radiant heat warmer. 2 2 Perform Apgar Score at 1 and 5 minutes of age. 3 3 4 4 5 5 Assess vital signs; perform brief physical assessment. Place matching ID bands on infant, mother and father. Place infant skin-to-skin on mother’s chest with father at her side; cover infant with warm blanket. Prevents evapora Rapid assessment based on five sign Assesses physiolo disposition of infa Safety feature to and parents. Provides neonata infant bonding an