CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-yo gravida 3, para

Question

CASE STUDY #1: LABOR AND DELIVERY SITUATION: Mrs. M. is a 27-yo gravida 3, para 2, who was admutted at temat 6:30 p.Tm. She stated that she had been having contractions at 7 to f0 mwnute itervals since 4 p.m. They lasted 30 seconds. She aiso sieied thal she hed been having "a iol af false iaho and hoped lhat his was the real thing. Hermambranes were intact. Mrs. M.'s were normal and her blood pressure was 124-80. The feial nearones were 134 and regular The nurse exaned Mrs. M. and found ihel the baby's head was a siaon, and ihe cervix as 4 cm. oated and 80 percent effaced. She reported her findings to the doctor and he ordered Deri 50 mg. with Phenergarn 25 mg. to be given intravenously whan needed. e, pulse and respirations 1. Do yau think Mrs. M. is in false labor? Give reasons for your answer 2. As Mrs. M. was getting into hed, her membranes ruptured. What is the tirst thing that you would do after this occurs? Why? 3. After her mernbranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55 seconds. They were moderately strong. Why is i important for Mrs. M. to relax during her contractions? How can you help her to relax? 4. When d you think Mrs. M. should be given the medication ordered by the doctor? What safety measures shod be taken at the time the medication i given? What observation:s should be made after it is given? Why? What observations would you report to the doctor? 5. How would you krnow 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 tine? The doctor gave her a pudendai block and did a midirne episiotomy. At 8:05 p.m. Mrs. M. geve tnh io a 7bs., 5 0z. f3.317gm.J boy in he L.O.A. posilion. The nurse pu medvine in the baby's eyes and placed an entiying bracelet on his nght wrist and ande. A matching bracelet was placed on the mother's wrist The baby was showm to his moiher ano hen taken o lhe newbon sery. AlOBp.m. fhe placenta was 7. Why is the medicine put in the babys eyes? 8. Why is it important to put identificatin on the baby in the delivery room? 9. What care should Mrs. M. receive before she is transferred to the recoery room. Why?

Explanation / Answer

Ans

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.

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