CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-y/o gravida 3, para
ID: 238262 • Letter: C
Question
CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that she had been having contractions at 7 to 10 minute intervals since 4 p.m. They lasted 30 seconds. She also stated that she had been having "a lot of false labor" and hoped that this was "the real thing". Her membranes were intact. Mrs. M.'s temperature, pulse and respirations were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular. The midwife examined Mrs. M. and found that the baby's head was at +1 station, and the cervix was 4 cm. dilated and 80 percent effaced. She reported her findings to the doctor and he ordered Demerol 50 mg. with Phenergan 25 mg. to be given intravenously when needed.
1. Do you think Mrs. M. is in false labor? Give reasons for your answer.
2. As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that you would do after this occurs? Why?
3. After her membranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55 seconds. They were moderately strong. Why is it important for Mrs. M. to relax during her contractions? How can you help her to relax?
4. When do you think Mrs. M. should be given the medication ordered by the doctor? What safety measures should be taken at the time the medication is given? What observations should be made after it is given? Why? What observations would you report to the doctor?
5. How would you know that Mrs. M. has entered the transition phase?
6. A vaginal exam revealed that Mrs. M. is complete and +2. What should be the nursing interventions at this time?
Explanation / Answer
1. Do you think Mrs. M. is in false labor? Give reasons for your answer.
Answer:
No, it is not a type of false labor.
Because in case of false labor does not produce any kind of dilatation of cervix, effacement, or descent.
Besides, contractions are irregular and without progression.
Dr. prescribed Meperidine (Demerol) to reduce pain and as pre and/or during surgery narcotic analgesic.
Besides, Promethazine (Phenergan) is used to prevent and treat nausea and vomiting related to certain conditions (such as before/after surgery, motion sickness) along with Demerol.
2. As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that you would do after this occurs? Why?
Answer:
Artificial rupture of membranes can be used to induce labor when the condition of the cervix is ripe or when the process is too slow.
If membranes have ruptured first to assess color of amniotic fluid because the rationale is that the meconium fluid can indicate fetal distress.
Factors that would necessitate a change to internal fetal monitoring after rupturing of the membranes.
3. After her membranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55 seconds. They were moderately strong. Why is it important for Mrs. M. to relax during her contractions? How can you help her to relax?
Answer:
Part 1:
Practice contractions may be painful or painless after spontaneous rupture of membranes.
Uterine contractions that forces acting to expel fetus. This includes effacement and dilation.
Need contractions and followed by relax to help pushing the fetus.
Intra-abdominal pressure from mother pushing and bearing down
Part 2:
By giving moral support in such a way that she should try to push the baby.
By giving some smooth muscle relaxant to relax the uterine muscles to avoid the chances of miscarriage.
4. When do you think Mrs. M. should be given the medication ordered by the doctor? What safety measures should be taken at the time the medication is given? What observations should be made after it is given? Why? What observations would you report to the doctor?
Answer:
Part 1:
When fetal bradycardia occurs and distress if delivery hasn’t occurred at the time of embolism.
If delivery is not occur naturally, need for scissor or surgery at that time need medications.
Part 2:
The drugs prescribed at that situation should be safe in pregnancy and safe in lactation and must be free from any teratogenic effects.
The drugs should not interfere the blood pressure and blood coagulation process.
Part 3:
First of all to record the blood pressure it should not be high.
Secondly, to observe the position and heart tone of fetus.
Thirdly, to see the amniotic fluid content, if it is less that means the fetus is dry so, immediate need to surgery.
Part 4:
The blood pressure is normal as mentioned 124/80 mm of Hg and fetal heart tones also normal and regular as mentioned as 134 beats per minutes.
Head position is good.
Please consider this note: Answering to many questions (more than four) is against to CHEGG RULE, so please post the remaining question once again.
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