CASE SIMULATION 115

Name Princess Levie Ceniza Class/Group BSN 2A GROUP 1 Date _______

Group Members_____________________________________________________
INSTRUCTION. All questions apply to this case study. Your responses should be
brief and to the point. When asked to provide several answers, list them in order
of priority of significance. Do not assume information that is not provided. Please
print or write clearly. If your response is not legible, it will be marked as?, and
you will need to rewrite it.

Scenario
You are the charge nurse working in labor room and delivery at a local hospital.
D.H. comes to the unit having contractions and feeling somewhat uncomfortable.
You take her to the intake room to provide privacy, have her change into gown,
and asks her three initial questions to determine your next course of action, that
is, where to do a vaginal exam or to continue asking her more questions
1. What three initial questions will you ask?
- has your water broken?
- where’s the pain felt?
-what time intervals are your contractions?

2. D. H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her

third pregnancy ( gravida 3, para 2002). Her bag of waters is intact at this
time. She states that her due date is 2 days way. You determine that it is
appropriate to ask for further information before vaginal exam is done.
What information do you need before vaginal exam?
- I would ask her if she has any allergies and under some medication also her due
date and if there is any complications in her previous deliveries.

3. What assessment should you make to gain further information from DH ?

 - I would check the position of the baby and monitor the mother blood
pressure and temperature. Also I would check the dilation, assess the pain
and the cervix effacement.

4. Upon examination, D. H. is 80% effaced and 4cm, FHR is 150 beats/min, and
regular. She is admitted to a labor and delivery room on the. What nursing
measures should be done at this time?
- The readings indicated that the mother is in the active labor.
- if the mother asks any question the nurse should answer it and the nurse
should place contraction and fetal monitor on D.H, also help her with
breathing and relaxing method to help her with the contractions.

5. As part of your assessment, you review the fetal heart strip pictured below.
What will you do?
- Nothing, these are early decelerations and are usually caused by fetal
head compression. 

6. List the stages of labor. DH. is in what stage of labor?

- in the first stage of labor includes early labor, active labor, and transition
to the second stage. The second stage is where the baby is born. The third
stage is the afterbirth. The fourth stage is recovery.
- D.H is in the active labor.

7. D.H. states that she is feeling discomfort and asks you whether there is
alternative therapy available before taking medication. List at least four
alternative methods to assist DH. with controlling her discomfort.
- I would advice her to have massage therapy especially for her back and
to take conscious breaths which will help her relax and use some pillow
to change her position which makes her comfortable and last is I could
apply some cold or heat to the areas which makes her feeling discomfort
.

8. As you assess both the mother and the fetus during active labor, you will
look for abnormalities. Which of these are potential abnormalities during
labor? ( select all that apply)
 a. Unusual bleeding
b. Brown or greenish amniotic fluid
c. Contraction that last 40 to 70 seconds
d. Sudden, sever pain
e. Increased maternal fatigue

CASE STUDY PROGRESS

Although D.H. Continues to use alternative therapies for discomforts, she asks for
pain medication and receives a dose of meperidine (Demerol). Three hours later,
D.H. is lying on her back, and during contractions you notice a few late
decelerations of the FHT. You stay with D. H. to monitor her and her fetus and
immediately call for someone to notify the PCP.

9. Put these actions in order of priority:

3 a. D/C the oxytocin infusion
1 b. Turn onto her left side and elevate legs
4 c. Increase the rate of the maintenance of IV fluid
2 d. Administer oxygen at 8-10L/min by facemask

10. Deceleration occur in an early, variable, or late pattern. What is the

significance of these patterns? State what the nurse should do for each
type.
-  Early decelerations are thought to be caused by fetal head compression
and are considered a
benign finding.
- Variable decelerations typically indicate cord compression. 
-  Late decelerations are considered to be more urgent because the fetus
might be in distress.

11. As you monitor D. H., you observe for prolapse of the umbilical cord.
 Describe what this is and what can happen to the fetus if this occurs.
- A prolapsed cord occurs when part of the umbilical cord lies below the
presenting part of the fetus. Fetal hypoxia results from prolonged cord
compression by the presenting part of the fetus.

12. What would be done if you noted prolapse?

- I would first call the physician for help immediately and the put on gloves then in
insert two fingers in her vagina to cervix, put some pressure on the parts that
presented so that I can compress the cord and then put her into extreme
trendelenburg or modified sims position.

CASE STUDY PROGRESS

The Decelerations stop, and the remainder of the labor is uneventful; D.H. has
an episiotomy to allow more room for the infant to emerge and delivers a
male infant.
13.What is involved in the immediate care of the new born?
- the baby should be dried with warm cloth while in the mothers hand or
abdomen and then make the baby skin to skin with the mother this is vital for
providing temperature to the baby. Also encourage the mother to bond with the
baby.

14.You asses the newborn, you observe for CNS depressant effects that might
result because the mother received an opioid during labor. Opioid
antagonist such as Naloxone ( Narcan) can promptly reverse the CNS
depressant effects in the newborn, but when is naloxone contraindicated
for infant? When Naloxone is contraindicated for infant?
-  An opioid antagonist is contraindicated for an infant of an opioid-
dependent woman because it may precipitate abstinence syndrome
(withdrawal symptoms).

15. D.H. has her episiotomy repaired and the placenta delivered. What are the
signs that the placenta has released from the uterine wall?
- the signs that the placenta has released from the uterine wall are firmly
contracted uterus, the uterus changes shape from a discoid to a globular ovoid
shape, the cord lengthens, sudden release of blood from the vagina, and finding
of vaginal fullness on vaginal examination.

16. What assessments are important following delivery?

- I would take the vital signs, assess uterine function, position and firmness.
Fundus must stay firm to control bleeding. Then administer oxytocin IM or
IV as ordered by the physician, next is monitor and document lochia,
document when the mother voids, and assess for bladder distention also
document the perineal bruising, edema, status of episiotomy, presesnce of
hemorrhoids and emotional state of D.H.

CASE STUDY OUTCOME

D.H. and her newborn baby boy are taken to the maternity unit where she begins
to breastfeed him.