Maternal Newborn Scenarios Ms. Susie Smith

Ms. Susie SmithRoom303 Ms. Susie Smith,33 y/o G2P0 at 42 weeks’ gestation. She is single with a limited support system. She has just completed a Non-Stress Test (NST) which was interpreted as being Non-Reactive. Her obstetrician has now ordered an Oxytocin-Stimulated Contraction Stress Test (CST). Fetal membranes are intact. Ms. Smith also has a history of hypertension and a previous pregnancy loss at 18 weeks’ gestation. She is crying and states “I can’t lose another baby”. External tocodynamometer and fetal ultrasound transducer remain in place from the NST. You responded correctly to6out of6evaluations: Category Educational Needs Fall Risk Health change Pain level Physiological Needs Sensorium Needs Your response Increased acuity Increased acuity Increased acuity Normal acuity Increased acuity Normal acuity Ex Status assessment reports order for additional testing Related to late stage of pregnancy and change of cen Status assessment reports post-term pregnancy with Status assessment does not indicate report of pain. Status assessment reports need for additional matern Status assessment reports no indication of altered se Ms. Susie Smith 33 y/o G2P0 at 42 weeks’ gestation. She is single with a limited support system. She has just completed a Non-Stress Test (NST) which was interpreted as being Non-Reactive. Her obstetrician has now ordered an Oxytocin-Stimulated Contraction Stress Test (CST). Fetal membranes are intact. Ms. Smith also has a history of hypertension and a previous pregnancy loss at 18 weeks’ gestation. She is crying and states “I can’t lose another baby”. External tocodynamometer and fetal ultrasound transducer remain in place from the NST. You correctly diagnosed12out of12options: Physiological Description Acute Pain Anxiety Bleeding Infection, Risk Nausea Risk for Impaired Fetal Gas Exchange Safety Your Response False True False False False True Description Deficient Knowledge Disturbed sensory perception Fall, Risk for Impaired Maternal Infant Bonding, Risk for Maternal Injury, Risk for Risk for Ineffective Coping Explan Status assessment reports no indication of pain. Status assessment reports patient crying and exp Status assessment reports no indication of bleedin Status assessment indicates intact membranes an Status assessment reports no indication of nausea Status assessment indicates post-term pregnancy be decreased affecting its ability to oxygenate fet Your Response Expl True Status assessment reports additional testing False Status assessment reports normal sensory pe True Status assessment reports mother is post-ter may increase risk for fall. False Status assessment reports no indication of in True True Status assessment reports planned use of ox titration to prevent uterine tachysystole. Risk assessment reports minimal family supp Ms. Susie SmithScenario1 You enter the patient’s room. After washing and gloving hands, you identify yourself and the patient, Ms. Susie Smith. Assessment findings: Vital signs: BP 144/90 mmHg, P 88 bpm, R 22 breaths/minute, FHR 134 baseline with moderate variability, no accelerations noted. No visible contractions on monitor tracing. Ms. Smith is teary and asks if her baby is going to be alright. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered1out of5actions: Your Correct order order Step 5 1 Discuss with woman fears about baby health; offer reassurance. 2 2 Educate woman on oxytocin contraction stress test (CST) procedure. 1 3 Have woman empty her bladder. 3 4 Position woman in Semi-Fowlers position with left lateral tilt. 4 5 Reassess placement of tocodynamoneter and transducer. Therapeutic communic relationship. Education allows for pl allays anxiety and redu Provides patient comfo Optimizes utero-placen secondary to vena cav Ensures accurate detec fetal movements. Ms. Susie SmithScenario2 Ms. Smith verbalizes understanding of purpose and process of the oxytocin Contraction Stress Test (CST). She appears much calmer and states she is ready to proceed with initiating the test. You assemble the needed supplies at her bedside; a standard concentration of 500 ml Lactated Ringer’s with 30 units oxytocin is used. After washing your hands, and donning non-sterile gloves, you are ready to proceed with CST. 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 1 1 Assess maternal vital signs. 2 2 3 3 4 4 5 5 Step E o Assess FHR baseline and reactivity. E t Assess monitor tracing for presence of contractions, palpate uterine A fundus for contractions. t Obtain IV access with #18 gauge IV catheter and begin 1000 ml M Lactated Ringer’s solution at 125 ml/hour on IV pump. v d Administer oxytocin intravenously through a secondary line connected P to the main line at the proximal port with an IV pump; begin at 1 d mu/min per healthcare provider prescription. Ms. Susie SmithScenario3 30 minutes later, the monitor tracing reveals uterine irritability, but no contractions present. Per healthcare provider order , it is time to increase the rate of the oxytocin. 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 Assess contraction pattern and Validate contraction pattern pe palpate uterine resting tone. indication to adjust oxytocin rat 2 2 Assess fetal status. Fetal status must be reassuring 3 3 Reassess maternal vital signs. Alteration in maternal vital sign 4 4 Increase oxytocin to 2 mu/minute per Assessment indicates continued healthcare provider order. contraction stress test protocol 5 5 Educate and reassure the client. Education allows for planning a Ms. Susie SmithScenario4 Thirty (30) minutes later the monitor tracing reveals three (3) contractions in a 10-minute period lasting 50 seconds, FHR baseline is 130 bpm, moderate variability, and absence of decelerations with contractions. Ms. Smith reports feeling mild discomfort with contractions. Vaginal bleeding is absent, no leaking of fluid per vagina. Vital signs: BP 140/80 mmHg, P. 76 bpm., R. 20 breaths/minute. 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 Palpate fundus for resting tone and contraction intensity. 2 2 Collaborate with healthcare provider on CST interpretation. 3 3 Discontinue oxytocin infusion. 4 4 Educate client on test results. 5 5 Document assessment and test results. To determine response to oxytoc Collaboration with healthcare pro results; No late decelerations of F Negative CST has been achieved provider. Negative CST indicative of positiv terminology. Accurate documentation is done Ms. Susie SmithScenario5 After communicating with healthcare provider regarding CST results, you are preparing to discharge Ms. Smith. As the maternal/fetal monitor transducers are being removed, Ms. Smith tells you that she feels like she may have urinated on herself. Upon visual assessment of the perineum, you observe clear fluid leaking from her vagina onto the underpads. 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 Using a sterile gloved hand, test fluid Nitrazine paper differentiate leaking from vagina with Nitrazine paper. 2 2 Reapply tocodynamometer and transducer Continued maternal/fetal ass to maternal abdomen. membranes and labor initiat rupture of membranes. 3 3 Maintain IV access with Lactated ringer’s To facilitate medication adm infusion. 4 4 Notify healthcare provider of assessment Healthcare provider and nur findings and collaborate on plan of care. to change plan of care and p 5 5 Reassure woman and educate on plan of Client will require teaching a care. in plan of care.