Alice, a primigravida, calls the labor unit. She tells a nurse that she thinks s

Question

Alice, a primigravida, calls the labor unit. She tells a nurse that she thinks she is in labor. “I have had some pains for about 2 hours. Should my husband bring me to the hospital now?” Provide EB rationale for all responses.

Describe how a nurse should approach this situation. Write several questions a nurse could use to elicit the appropriate information required to determine the course of action required. Based on the data collected during the telephone interview, the nurse determines that Alice is in very early labor. Because she lives close to the hospital, she is instructed to stay home until her labor progresses. Outline the instructions and recommendations for care Alice and her husband should be given for the nursing diagnosis: Readiness for enhanced knowledge of labor progression RT lack of exposure.

Part 2

Question: Answer the following questions and provide rationale for the answer choice:

A woman has just arrived at the labor and delivery suite. To report the client’s status to her primary health care provider, which of the following assessments should the nurse perform? Select all that apply.

a)      Fetal heart rate

b)      Contraction pattern

c)      Contraction stress test

d)      Vital signs

e)      Biophysical profile

Explanation / Answer

At the beginning of labor a nurse must need to set up a bed for the patient. once the patient is in comfortable positision the nurse should start with checking the vital signs of the mother.

MATERNAL VITAL SIGNS. Maternal vital signs are assessed to identify signs of hypertension and infection. Hypertension during pregnancy is defined as a sustained blood pressure increase to 140 mm Hg systolic or 90 mm Hg diastolic. The hypertension may be a disorder that is specific to pregnancy or it may be chronic like pre-eclampsia and eclampsia A temperature of 38° C (100.4° F) or higher suggests infection.

FETAL HEART RATE. Fetal Assessment A fetal assessment identifies well-being and signs indicative of compromise. It primarily focuses on determining the FHR pattern, but the character of the amniotic fluid is also assessed. Analysis of the FHR is one of the primary evaluation tools used to determine fetal oxygen status indirectly. FHR assessment can be done intermittently using a fetoscope (a modified stethoscope attached to a headpiece) or a Doppler (ultrasound) device or continuously with an electronic fetal monitor applied externally or internally. Intermittent FHR monitoring affords the advantage of mobility for the woman in the first stage of labor. She is free to move around and change position at will since she is not attached to a stationary electronic fetal monitor. However, intermittent monitoring does not document how the fetus responds to the stress of labor and does not provide a continuous recording of the fetal heart rate. In addition, it does not show the fetal response during the acme of a contraction, because intermittent monitoring is typically done after a contraction, when the uterus is relaxed. The pressure of the device during a contraction is uncomfortable and can distract the woman from using her paced-breathing patterns. A lower limit of 110 beats per minute (bpm) and an upper limit of 160 bpm Regular rhythm Presence of accelerations in the FHR Absence of decelerations from the baseline These findings also would be reassuring in an electronically monitored fetus .  

  They recommend the following guidelines for assessing FHR: •

Biophysical profile : A biophysical profile uses ultrasound during a nonstress test to measure a series of physical traits . mother may have more than one contraction stress test while you are pregnant. BPP is a prenatal ultrasound evaluation of fetal well-being involving a scoring system with the score being termed Manning's score.[2] It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.

The BPP has 5 components: 4 ultrasound (US) assessments and an NST. The NST evaluates fetal heart rate and response to fetal movement. The five discrete biophysical variables:

if it shows abnormality in biophysical profile then the contraction test need to be performed.

Recommended management based on the biophysical profile[5] BPP Recommended management ?2

• Labor induction

4

• Labor induction if gestational age >32 weeks
• Repeating test same day if <32 weeks, then delivery if BPP <6

6

• Labor induction if >36 weeks if favorable cervix and normal AFI
• Repeating test in 24 hours if <36 weeks and cervix unfavorable; then delivery if BPP <6, and follow-up if >6

8

• Labor induction if presence of oligohydramnios.   

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