Maternal Newborn Scenarios Aminiah Hussain

Aminiah HussainRoom303 Aminiah Hussain,22-year-old Muslim female, G1 T0 P0 A0 L0, 39 5/7 weeks gestation. NKDA. Pregnancy uncomplicated. Woke up early morning feeling wet; wasn’t sure if leaking urine or membranes ruptured. Has continued to stay wet and needed to wear a pad for the last 4 hours. No contractions or vaginal bleeding. Her husband, Mohammad, is with her. He is attending his first year of medical school at the University and both are in the United States on VISAs. He called the obstetrics ofÏce and the certified nurse midwife told them to come to the hospital for evaluation and possible induction of labor. Aminiah looks to her husband to answer questions. He reads English fluently but both Aminiah and her husband struggle to speak and understand English conversation. Both appear nervous and have a lot of questions about an induction. 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 Explan Status assessment reports r/t first pregnancy and induction o Status assessment reports r/t 39+ weeks gestation and chan Status assessment reports r/t Premature Rupture of Membran No contractions at this time. Status assessment reports r/t concern about situation and lan Quiet but alert and oriented, no indication of problems in stat Aminiah Hussain 22-year-old Muslim female, G1 T0 P0 A0 L0, 39 5/7 weeks gestation. NKDA. Pregnancy uncomplicated. Woke up early morning feeling wet; wasn’t sure if leaking urine or membranes ruptured. Has continued to stay wet and needed to wear a pad for the last 4 hours. No contractions or vaginal bleeding. Her husband, Mohammad, is with her. He is attending his first year of medical school at the University and both are in the United States on VISAs. He called the obstetrics ofÏce and the certified nurse midwife told them to come to the hospital for evaluation and possible induction of labor. Aminiah looks to her husband to answer questions. He reads English fluently but both Aminiah and her husband struggle to speak and understand English conversation. Both appear nervous and have a lot of questions about an induction. You correctly diagnosed10out of11options: Physiological Description Acute Pain Chronic Pain Injury, risk for Safety Description Fall Risk Injury, risk for fetal Your Response False False True Your Response True True Ex No current pain; no contractions. No history of chronic pain. Status assessment reports r/t rupture of Explana Status assessment reports r/t shifting center of grav Status assessment reports r/t risk for fetal hypoxia w Your Description Response Injury, risk for True maternal Love and Belonging Description Anxiety Deficient Knowledge Disabled Family Coping Fear Spiritual Distress, risk for Explana Status assessment reports r/t risk for infection, uteri of labor. Your Response Explanati True Status assessment reports r/t unknown impact of current husband. True Couple asking questions about induction of labor; first pr False No evidence. Husband accompanies. False True No specific fears voiced; although the client and husband Status assessment reports r/t potential discrepancy betw healthcare management, and privacy issues. Aminiah HussainScenario1 After obtaining report, the nurse looks in the computer for Aminiah’s prenatal record and lab reports. She is Blood type A+, Rubella immune, and GBS negative. The nurse enters Aminiah’s room to begin the initial admission assessment. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correc order t order Step 1 1 Wash hands and introduce self to the client Washing hands upon enter and her husband. infection. Introductions bef 2 2 Ask client and her husband what they prefer to Use of first names and surn be called. should not make assumpti may be considered disresp it should be used. The nurs called and record this in th 3 3 Ask if there is need for an interpreter or Speaking and reading may translator and any specific privacy needs for oral communication an during the assessment. be asked about their priva assessments, and gender o 4 4 Ask permission prior to touching the patient. The appropriateness of tou Obtain her vital signs, fetal heart tones, and with introductions and mak perform a pain assessment. Ask about time of to obtain vital signs and fe rupture of membranes and observe color of stability of the mother and fluid. often be detected by a cha ROM and characteristics of 5 5 Educate client about the status of the fetal Since the mother is anxiou Your Correc order t order Step heart tones. the nurse assessed about Aminiah HussainScenario2 The nurse completes an initial assessment. T 37 C, 98.6 F, P 80 bpm, regular; R 18 breaths/min., regular; BP 118/78 mmHg; 0/10 Pain. FHR 140, moderate variability, 2 accelerations to 155 in 20 minutes. No contractions on EFM. The client wishes to be called Aminiah and her husband prefers to be called Dr. Hussain. He doesn’t think they need an interpreter but would like written information about the induction. Dr. Hussain states he will answer questions for his wife and sign any consent forms. Aminiah nods her head that this arrangement is “OK” with her. The nurse now continues with a cultural and spiritual assessment and selects questions to be asked during the assessment as nursing actions. 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 Ex 1 1 Who do you want to be with you in Social class and cultural norms also aff labor? and women. In the Muslim culture, wom children. Children are highly valued an usually view the birthing process as a f decision making. This first question ad 2 2 What can your labor support Nurses should exercise sensitivity in w person do to help you be most assess the ways in which they apply th comfortable during labor? second question will clarify the role of 3 3 What actions are important for you Nurses should ask questions about cult and your family immediately after the early newborn days which are a pa the baby’s birth? component of holistic nursing and thus this will be after delivery. 4 4 What do you expect from the Nurses may be requested to provide th nurses caring for you during the There may prayers, spiritual rituals, or postpartum period? postpartum period. 5 5 How will other members of your Family roles involve the expectations a family participate in the care of position in the larger family system. Th you and the new baby once you go and provide a chronological order for t home? Aminiah HussainScenario3 Dr. Hussain states he will be present for decision making but that the certified nurse midwife that Aminah has been seeing throughout the pregnancy, Beth, and the staff nurse will support Aminah during the labor and birth process. Only female health care providers will be allowed into the room. Privacy and modesty are very important to both of them. They wish to allow Allah to provide for comfort and not have any medications. As father, he wishes to whisper prayers into the baby’s ear shortly after birth and pin a verse from the Qur’an to the newborn’s clothing for protection. Aminah will breastfeed the baby for 2 years. Prior to the first feeding, she will need to rub a small piece of softened date onto the baby’s palate. Aminah’s sister will be traveling to the US to assist with the care of the baby as he will be returning to his residency program. They will use social media to contact their family after the baby’s birth once both mother and baby have been cleaned up and fed. The nurse uses the answers to the cultural and spiritual assessment to blend with labor and birth protocols and develop a plan of care. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correc order t order Step 1 1 Provide written information and instructions about the induction of labor protocols to the husband. Allow the health care provider to explain the process and answer questions. Allow the client’s husband to sign the consent on her behalf. 2 2 Female health care providers only. Keep client covered as much as possible and use non-pharmacological comfort measures. Minimize vaginal exams for both comfort and to decrease risk of infection. 3 3 After birth, dry the newborn and allow the father to hold the baby briefly before placing skin to skin with mother. 4 4 Assess 1-minute Apgar score while in father’s arms and 5minute score on mother’s abdomen- unless there is need for neonatal resuscitation. 5 5 Husband prefers best in this form healthcare prov instructions. Clie her. Consent sho Muslim religion due to modesty vaginal exams d infection becaus Drying the newb is holding the ne The Apgar score the neonate is in able to hold the ABC’s come prio Allow mother to rub a soft date on newborn’s palate prior Combining their to feeding. Assist the newborn to breastfeed within the breastfeeding sh first hour. newborn. Breast Your Correc order t order Step demonstrated to Aminiah HussainScenario4 The certified nurse midwife answers the husband’s questions about the induction process and protocol. Dr. Hussain signs the written consent for his wife. The midwife, Beth, performs a speculum exam and it is found to be positive for pooling of clear amniotic fluid, positive Nitrazine and positive Ferning to confirm rupture of membranes. The cervix is soft, anterior, and 2 cm dilated, 50% effaced, -1 station. Bishop score is 8 showing cervix favorable for induction. Orders given by Certified Nurse Midwife for induction with oxytocin protocol. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered5out of5actions: Your Correc order t order Step 1 1 Assess fetal status with continuous electronic When placental perf monitoring and evaluate/document every 15 minutes frequent or prolonge Your Correc order t order 2 2 3 3 4 4 5 5 Step and with every change of oxytocin dosage. acidemia; eventually absent baseline varia Assess contraction pattern and resting tone every 15 The goal of oxytocin minutes and with every change of oxytocin dosage; intensity, duration, a document. dose of medication. of uterine tachysysto fetal stress. Initiate primary IV with Normal Saline solution. The nurse implemen intravenous infusion Oxytocin 30 units/500 mL Normal Saline IV through Oxytocin is a high al secondary line at 1 mu/min by infusion pump at 1 for causing significan mL/hr. Increase by 1-2 mu/min, every 30-60 minutes, 30 units oxytocin in based on the woman, fetus, and progress of labor. and less risk for erro minutes is based on 40 minutes to reach the dosage incremen longer contractions. error. Assess BP, pulse, respirations every 30-60 minutes, Oxytocin use can pre and with every change of oxytocin dosage; abruption or uterine document. complications. Aminiah HussainScenario5 Eight hours later, the oxytocin dosage is at 16 mu/min (16 mL/hr). Aminiah’s vitals: T 37.4 C, 99.3 F, Pulse 94 bpm and regular, BP 128/84 mmHg. Pain level 8/10 with some involuntary “grunting” at the peak. Client has tears coming down her cheeks. Her husband is pacing in room. The midwife rubs her back and coaches her in breathing. FHR baseline 145 with moderate variability. Contraction pattern: q2min, 90 second duration, strong. There have been 6 contractions in 10 minutes. Fetal heart tones decelerate to 80 beats/minute during the contraction but does not return to baseline at the end of the contraction. The midwife conducts a sterile vaginal exam to check for cervical dilation and assess for umbilical cord prolapse. 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 Discontinue the oxytocin infusion. 2 2 Reposition the client to the other side. 3 3 Administer oxygen via nonrebreather face mask at 10 L/min. 4 4 Administer IV fluid bolus of 500 mL/hr. 5 5 Expla Tachysystole is defined as more than 5 contra due to stimulated labor, the nurse should imm Side lying position decreases pressure on the placenta and fetus. This intervention may be Enhance oxygenation to the fetus by adminis intervention is quickly and may be done if the Late decelerations do not return to baseline a hypoxemia. A fluid bolus will increase matern intervention is completed if the first 3 actions fetal distress. Administer terbutaline 0.25 Terbutaline is a tocolytic to relax the uterine s mg subcutaneously. the last action, if the other interventions do n