Case Study 1.

Name: BLANCAFLOR, Kim Frances G. Level: 2 Group: 1B Date: April 05, 2020

INSTRUCTIONS. All questions apply to this case study. Your responses should be brief and direct to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that is not
provided. Please write your answers clearly/legibly. Corresponding credit (score)will not be given for answers that are
not readable. Scan/take a picture of your answers and submit/upload the file thru VLE/MESSENGER/EMAIL.

Test 1 Case Scenario

 Scenario: You are the nurse working in labor and delivery unit at a local hospital. Ms. AB comes to the unit
having contractions and appears somewhat uncomfortable. You take her to the intake room to provide privacy,
have her change into a gown, and ask her three initial questions to determine your next course of action, that is,
whether to do a vaginal exam or to continue asking her more questions.
1. What three initial questions will you ask, and why?
1. “How may months have you been pregnant?” so you can determine the AOG.
2. “Did your water broke already?” because it increases the frequency and intensity of contractions.
3. “Have you experienced any unusual bleeding or vaginal discharge?” to assess possible hemorrhage and prevent
it.

2. She states that her last monthly period was last June 10, 2019. Compute for the AOG and EDC.
1. AOG 43 weeks, 5 days
2. EDC March 17, 2020

3. Ms. AB has contractions 2 to 3 minutes apart lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her
bag of water is intact at this time. Upon checking her UTZ report, her due date is 2 days away. You determine that it
is appropriate to ask for further information before a vaginal exam is done. What information do you need?
- Ask if there are any abnormalities from the past pregnancies and what medications were taken.

4. Upon examination, Ms. AB is 80% effaced and 6 cm dilated. The fetal heart rate (FHR) is 152 beats/min and regular.
She is admitted to the labor and delivery room in the unit. What nursing measures should be done at this time?
- Assist and instruct mother to perform proper breathing technique and pushing for 10 seconds (during
contractions only) prepare all the necessary equipment needed.

5. List the stages of labor. Ms. AB is in what stage of labor?

- Stage 1: Effacement and Dilatation of the cervix
- Stage 2: Fetal Stages
- Stage 3: Placental Delivery
- Stage 4: Postpartum

6. Ms. AB states that she is experiencing discomfort and asks you whether there is an alternative therapy available
before taking medication. List at least two alternative methods in order to alleviate her discomfort.
- Proper positioning
- Proper Breathing Technique

7. As you assess both the mother and the fetus during the active stage of labor, you will watch out for abnormal
findings. Which of these are potential abnormal findings during labor?
(Select all that apply.)
a. Unusual bleeding
b. Brown or greenish amniotic fluid
c. Contractions that last 40 to 70 seconds
d. Sudden, severe pain
e. Increased maternal fatigue
Answer: A, B, C

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  Case Study Progress
Although Ms. AB continues to use alternative therapies for discomfort, she asks for pain medication and receives
a dose of Hyoscine-N-Butyl bromide (Buscopan) 10 mg IM and IV. Three hours later, MS. AB. is lying on her back,
and during contractions you notice a few late decelerations of the FHR. You stayed with Ms. AB to monitor her
and her fetus and immediately call for someone to notify the attending Physician.

8. Put these actions in order of priority:

a. Discontinue the oxytocin infusion.
b. Turn Ms. AB onto her left side and elevate her legs.
c. Increase the rate of the maintenance IV fluids.
d. Administer oxygen at 8-10 L/min by facemask.
Answer: A, B, C, D

9. What are the 3 patterns of deceleration?

- Early Deceleration
- Late Deceleration
- Variable Deceleration

10. As you monitor Ms. AB, you observe for prolapse of the umbilical cord. Describe what this is and what can happen
to the fetus if this occurs.
- Cord prolapse happens when the umbilical cord drops through the cervix and pushes into the birth canal before
the baby. It gets trapped against the baby’s body, thereby blocking the blood and oxygen supply.

11. What would be the appropriate nursing actions if you noted that Ms. AB had a prolapsed cord?
- Place client in a Trendelenburg position.

 Case Study progress

The decelerations stopped, and the remainder of the labor is uneventful; Ms. AB had an episiotomy to facilitate
the delivery of a male infant.

12. What are the essential interventions in the immediate care of the newborn?
- Dry baby
- Perform quick assessment (APGAR)
- Initiate skin to skin contact
- Wrap baby with clean cloth
- Clamp then cut the cord.
- Administer Vit. K, Hep B Vaccines.

13. Ms. AB. has her episiotomy repaired and the placenta delivered. What are the signs of placental expulsion?
- Lengthening of the cord
- Sudden gush of blood
- Change in shape of the uterus
- Appearance of the placenta in the vaginal opening

14. What assessments are important for Ms. AB following delivery?

- Determine client’s vital signs.
- Assess for any signs of unusual bleeding.
15. What interventions must be done in order to achieve and maintain a well contracted uterus to prevent
hemorrhage?
- Administer oxytocin
- Massage uterine area
- Facilitate breastfeeding

 Case Study Outcome:

Ms. AB and her newborn baby girl are taken to the maternity unit where she begins to breastfeed her.
16. What are the proper breastfeeding instructions that must be given to Ms. AB.

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 - Wash hands before breastfeeding
- Support Mother’s body (especially the back to provide comfort)
- Assist and instruct mother on how to properly hold, support and position the baby.
- Ask mother to hold the baby close to her as much as possible.
- Ask mother to hold her breast with thumb and four fingers underneath and always keep it away from the
areola.
- Ask mother to support the base of the baby’s head between the thumb and fingers.
- Instruct mother for signs of good attachment like:
i. Baby opens his mouth wide with lips flanged out.
ii. More areola is visible above the baby’s lips than below.
iii. Baby’s chin is pressed onto the breast.
iv. Pause notice in between sucking.
- Instruct mother for other breastfeeding position like:
i. The Cradle Hold
ii. The Transitional Hold
iii. The Football Hold
iv. The Side-lying hold
- Instruct mother how to burp her baby. (2 ways)
i. Place a small towel over your shoulder. Hold baby upright against shoulder, and gently pat and
rub baby’s back.
ii. Sit baby upright on your lap. Support his chest and chin with your hand, while stabilizing his
head, and gently rub baby’s back.

Prepared by: Sharon M. De Vera RN, MAN

Faculty NEU-CON