Maternal Newborn Scenarios Sarah Lane

Sarah LaneRoom305 Sarah Lane,Mrs. Sarah Lane is a 25 y/o G2P0 who is at 42 weeks gestation. Estimated fetal weight is 4000 Gm. She presents to the Maternal-Fetal Medicine Clinic today for a Non-Stress Test (NST). Her first pregnancy ended in a miscarriage at 10 weeks gestation. Her husband has accompanied her to every prenatal visit; they both appear anxious regarding the test and the health of their baby. You responded correctly to5out of6evaluations: Your Category response Educational Needs Increased acuity Fall Risk Increased acuity Health Change Increased acuity Pain Level Normal acuity Psychological Increased Needs acuity Sensorium Normal acuity Explanation Status assessment reports anxiety regarding impending non-stress test and h Client is 42 weeks pregnant and changes in center of gravity and balance inc Status assessment reports post-term pregnancy: testing determines whethe Status assessment does not indicate report of pain. Status assessment reports post-term pregnancy. Testing is used to determin insufÏciency Status assessment reports no indication of altered sensorium. Sarah Lane Mrs. Sarah Lane is a 25 y/o G2P0 who is at 42 weeks gestation. Estimated fetal weight is 4000 Gm. She presents to the Maternal-Fetal Medicine Clinic today for a Non-Stress Test (NST). Her first pregnancy ended in a miscarriage at 10 weeks gestation. Her husband has accompanied her to every prenatal visit; they both appear anxious regarding the test and the health of their baby. You correctly diagnosed12out of12options: Physiological Description Acute Pain Anxiety Bleeding Infection, Risk Risk for Fetal Injury Risk for Impaired Fetal Gas Exchange Safety Your Response False True False False True True Explan Status assessment reports no indication of pain. Status assessment indicates previous pregnancy l Stats assessment reports no indication of bleeding Status assessment reports no indication of infectio Status assessment indicates macrosomic infant, in operative delivery. Status assessment indicates post-term pregnancy be decreased affecting its ability to oxygenate fet Your Description Response Expl Deficient knowledge True Status assessment indicates woman and hus Disturbed sensory perception False Status assessment reports normal sensory pe Fall, Risk for True Status assessment reports client is post-term place her at risk for falls. Risk for Altered Family False Status assessment reports husband attendin Process Your Description Response Expl Risk for Ineffective Individual True Status assessment indicates previous pregna Coping pregnancy Risk for Maternal Injury True Status assessment indicates NST to be perfor supine hypotension. Sarah LaneScenario1 After reviewing the patient’s prenatal history, you enter the patient’s room, identifying yourself and the patient, Mrs. Sarah Lane, and greeting her husband. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered2out of5actions: Your orde Correc r t order Step 1 1 Wash hands and apply non-sterile gloves. 3 2 Review patient prenatal history with woman, confirming understanding of reasons for NST. 5 3 Have woman empty bladder. 4 4 Educate woman and husband on process of Explanation Prevents nosocomial infection. Care planning requires accurate, updated patient history and should be done prior to any care. Provides patient comfort during procedure. Education allows for planning and Your orde Correc r t order Step NST. 2 5 Obtain maternal Vital Signs. Explanation implementation of patient care. Establishes baseline maternal vital signs and should be done immediately prior to the test. Sarah LaneScenario2 Mrs. Lane has indicated understanding of NST procedure. Her husband remains at her side and both are ready to begin Non-Stress test, NST. 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 Position patient in reclining chair (or semi-Fowlers position) with left lateral tilt. 2 2 Perform Leopold’s Maneuver. Optimizes utero-placental perfu secondary to vena cava compre Identify position of fetus and loc tocodynamometer and the dopp Your Correct order order Step 3 3 Apply doppler transducer to abdomen over location of fetal back. 4 4 Apply tocodynamometer to uterine fundus. 5 5 Teach patient to use handheld event marker connected to monitor Detects and records FHR which Detects and records uterine con If evidence of fetal movement n depresses marker when feels m a final step in this scenario. Sarah LaneScenario3 After 10 minutes, no fetal movement or FHR accelerations are recorded on the monitor tracing. FHR baseline rate is 134 BPM with moderate variability. Mrs. Lane states she has “twinges” but unsure of fetal movement. 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 Readjust woman’s position to opposite side, ensuring lateral tilt and provide ice chips or small amount of po fluids. 2 2 Reassess maternal vital signs. 3 3 Palpate for fetal movement. 4 4 Adjust tocodynamometer and transducer. First, fetal moveme to ensure utero-plac simulate fetal move Next, it is important which decreases ut Mother may not per depress event mark Proper placement o Your Correct order order 5 5 Step Confirm patient understanding of procedure, reassuring patient of fetal status. and documentation Ensures patient coo perceived fetal mov variability. Sarah LaneScenario4 After 10 additional minutes of monitoring, a few fetal movements are noted on monitor tracing and indicated with remote event marker. One FHR acceleration of 10 BPM above the baseline is noted. 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 Reassess fetal position using Leopold’s Maneuver and Reassessment wi placement of transducer. assessment and d 4 2 Extend testing time for an additional 20 minutes. Based on reasses further evaluation change, and test 3 3 Educate patient and husband on the use of Uses a combinati vibroacoustic stimulation procedure. and alter fetal sta 2 4 Monitor for 5 minutes before stimulation. To obtain a basel 1 5 If baseline remains nonreactive, activate vibroacoustic Desired result is a stimulation device for three seconds on maternal minutes of stimu Your Correct order order Step abdomen over fetal head. Sarah LaneScenario5 Following an additional 20 minutes of testing, along with 2 additional applications of vibroacoustic stimulation, two accelerations lasting at least 15 seconds and peaking at least 15 beats/min above the baseline are noted on monitor tracing. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: You correctly ordered0out of5actions: Your Correct order order Step 2 1 Review monitor tracing and interpret NST results 4 2 1 3 5 4 3 5 First a Re Consult with prescribing healthcare provider regarding assessment Coll findings and NST interpretation. inte care Educate woman and husband on NST results. Edu of p Schedule woman for follow-up NST (twice-weekly) if delivery has To a not occurred. deliv Document performance of procedure, patient tolerance, and Acc collaboration with healthcare provider regarding interpretation of of p results.