BACHELOR OF SCIENCE IN NURSING:

INTENSIVE NURSING PRACTICUM

RLE LCP MODULE RLE LCP UNIT WEEK
3 1 1
HYPERTONIC UTERINE CONTRACTIONS
  Read course and laboratory unit objectives
 Read study guide prior to class attendance
 Read required learning resources; refer to course unit terminologies for jargons
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

UNIT EXPECTED OUTCOMES

At the end of this unit, the students are expected to:

1. Apply the nursing process in the care of groups of obstetrical clients with conditions of
specific labor dysfunction
a. Assess the client’s total health condition and resources.
b. Formulate nursing diagnoses based on the given scenario.
c. Develop a plan of care specific for clients with Hypertonic Uterine Contractions
d. Implement a plan of care applying the appropriate principles and guidelines in the care
of clients with such condition/situation.
e. Evaluate the outcome(s) of care.
2. Demonstrate competencies of a beginning staff nurse, nurse leader, and researcher.
3. Promote personal and professional growth by showing independence in performing varied
tasks and responsibilities.

Skills laboratory equipment and materials

To facilitate the practice of students’ nursing skills, the following rules must be implemented:
1. The use of the Nursing Skills laboratory equipment and materials appropriate to the given
case scenario are allowed.
2. Use resources from the required readings.
3. Students must perform the tasks in the worksheet at a given period.

Key Areas of
Competency
Responsibility
1. Safe and Demonstrates knowledge
Quality Nursing about the clients’ health status
Care and set priorities in nursing
care based on clients’ needs
Provides sound decision
making in the care of
Expected Performance and Criteria
Identifies the client’s health status and
determines priority need/s related to
hypertonic uterine contractions.
Gathers and analyzes data relevant to the
client’s health condition related to HUC.
 Key Areas of
Competency Expected Performance and Criteria
Responsibility
individual/ family considering
their beliefs and values
Promotes safety, comfort, and Maintains a safe environment and performs
privacy appropriate procedures and protocols safely
ensuring privacy in all aspects of care.
Administers medications and Conforms to the 10Rs of medication
other health therapeutics administration and health therapeutics
safely (accurately and
correctly)
2. Management Organizes workload to Identifies nursing tasks and performs them
of Resources facilitate client care. based on priorities.
Finishes tasks on time.
Observes appropriate protocols and
institutional policies.
Utilizes resources to support Ensures availability, completeness, and
client care by ensuring proper functionality of equipment and nurse’s
functioning of equipment paraphernalia relevant to the care of clients
with HUC.
3. Health Develops health education Implements applicable age-appropriate health
Education plan based on assessed education activities to the client based on
learning needs needs assessment
4. Legal Adheres to practices in Acts and performs nursing tasks related to the
Responsibility accordance with the nursing care of clients with HUC in accordance with
law, institutional policies and established norms of conduct expected of a
protocols, and other relevant nurse and an OLFU student as well as with the
legislation. other relevant legislations.
5. Ethico-moral Adheres to Code of Ethics of Maintain the privacy and confidentiality of
responsibility Nurses and respect rights of client’s information.
the client and other individuals Accepts responsibility and accountability on
involved in the care of the the decisions made relating to the client’s
client. care.
6. Personal and Project a professional image Performs nursing tasks according to
Professional of the nurse professional standards.
Development Demonstrates good manners and right
conduct at all times.
Observes proper grooming and hygiene.
Adapts to changes willingly by being open to
new strategies or approaches relevant to the
care of clients with HUC.
7. Quality Identifies and reports Identifies and reports inadequacies and
Improvement variances and recommends problem(s) encountered in the provision of
appropriate solutions. care.
Recommends practical and appropriate
solutions.
8. Research Enhances competency level in Specifies researchable problems related to the
the utilization of different care of clients with HUC and its related
forms of data gathering and procedures.
principles of assessment and Gathers, analyzes, and interprets relevant
 Key Areas of
Competency
Responsibility
nursing care.
Analyzes and interprets data,
disseminate findings and
apply recommend actions.
9. Records Maintains accurate and
Management updated documentation of
client care observing legal
imperatives in documentation
and record keeping.
10. Communicatio Identifies verbal and non-
n verbal cues
Uses appropriate information
technology to facilitate
communication.
11. Collaboration Collaborates plan of care with
and Teamwork the other health care team
members.
Expected Performance and Criteria
data.
Utilizes findings in research in the provision of
measures client care specific to HUC..
Records outcome of client care.
Submits legible, accurate and updated
documentation and/or information regarding
the client care.
Interprets and validates client’s body language
and facial expressions
Utilizes appropriate means and/or channels of
communication to support the delivery of care
to clients with HUC..
Respects the role of other members of the
health care team in implementing measures to
the client.
Refers the client to the appropriate allied
health team partners.

CASE SCENARIO

L.S., a 29-yr-old G2P1 client was on her 38th week of pregnancy when admitted in spontaneous
labor at 5:00 p.m. of August 11, 2019, in a local maternity hospital. Her first pregnancy was without
any complication. However, in this second pregnancy she was treated with ritodrine, from 29 to 37
weeks gestation due to premature contractions.

Her initial examination revealed that the cervix was 1 cm dilated with complete effacement. The
fetus presented with a vertex position in Hodge II. Vital signs were: Temp. 37°C, PR= 82/min, RR=
20/min BP= 120/80

Admitting Orders were:

D5LR 1L to run for 12 hours
NPO temporarily
CBC, HBsAg, Blood typing, Cross-matching 1unit FWB
CBR w/o BRP
Monitor and record FHT, contractions
Refer for progress of labor
While in the Labor Room, a first spontaneous hypertonic and prolonged contraction occurred at
7:40 p.m. with accompanying prolonged deceleration. The fetal heart rate went down to 54
beats/min for 8 min. The attending physician immediately made the following orders:

- Place patient on side-lying position.

- Monitor FHT and contractions closely
.
The FHR returned to 110 and 120 /bpm quickly with a good beat-to-beat variation. At 9.20 p.m.
another spontaneous hypertonic contraction occurred with a prolonged deceleration which
normalized rapidly after putting the patient again in the side position. The cervix was still 1 cm
dilated and amniotomy was performed, revealing clear amniotic fluid. The planned fetal pH
determination was not performed because of the clear amniotic fluid and the rapid recovery of the
FHR. Vital signs were: BP: 130/90, PR= 89/min. RR= 22/min , T=37°C

Another order was made at this point:

- Maintain patient on side lying position

- O2 inhalation via face mask PRN
- Mg So4 20% 2g. slow iv push “stat”
- Monitor vital signs
- Prepare for possible caesarean section

But because of the good beat-to-beat variation, good fetal movements and the quick
disappearance of the deceleration in the side position, it was decided that a caesarian section
should not be performed yet.

One hour later the contractions became regular but were consistently hypertonic and prolonged.
Every l0-15 minutes, a contraction lasting for 5-7 min occurred. The cervix progressed quickly from
6 cm to full dilatation within 30 min and at 3.00 a.m. a healthy baby boy weighing 3250 g, was
born, Apgar 9 at 1 min. The placenta was out at 3:05 am, weighed 500 g and was visibly normal
and complete

Tasks:
Complete the following activities :

1. Compute for the following:

- D5LR 1 L to run for 8 hours. How many drops/min. (drop factor= 15gtts/cc
- Order: Mg So4 20% 2g. slow iv push “stat” (Stock dose= 20% at 10g./50 ml)
How many ml. should be given?

2. Questions:
a. What is the indication for Mg So4 in this patient?
b. How should it be administered intravenously?
c. What is/are the adverse effects of this drug to the mother/fetus which need to be watched
out for?
3. Fill in the data required in the partograph based on the scenario.
REFERENCES
https://gpnotebook.com/simplepage.cf m?ID=-200933368
https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-
complications-of-labor-and-delivery/protracted-labor
https://browntrialfirm.com/birth-injury-lawyer/uterine-hyperstimulation/