Labor and Delivery Assignment 2

NURS 352: Labor and Delivery Critical Thinking Assignment
40 points
1.Patient Summary:
Age: <18  18-22 22-30  30-35 >35 
Marital status:  Married  SPK, relationship with FOB  SPK, estranged from FOB  SP-NK
Gravida: 1 Para: 0 TPAL: 0000
Gestational age: 37W 4D  Preterm  Term  Post-term
 SOL (spontaneous onset of labor)
Augmentation? Yes or no
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If yes, with what means (Pitocin, AROM) ____________________________________________
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 IOL (Induction of labor) Reason why: baby B with IUGR
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What medications were used in the IOL: Pitocin
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Type of delivery:  Vaginal  C – Birth (*this did not occur during clinical but after I had left for the day, although I
was notified of the results of my patient’s labor)  Forceps  Vacuum extractor
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 Episiotomy  Laceration, Degree of laceration__________

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Gender of Newborn  Boy  Girl  Surprise! (Unknown gender during labor)

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Birth weight: unknown; delivery did not occur while at clinical
Length: unknown; delivery did not occur while at clinical

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Apgars: unknown; delivery did not occur while at clinical

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Complications during transition/stabilization for newborn (See APGAR scoring. If less than 7, why?) N/A
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2.Prenatal History:
Prenatal care  Preterm  Term  Post-term
Weight gained during pregnancy? 45lb (25-35 lb)
Prenatal education (what classes): Breastfeeding Class, Childbirth Preparation, Basic Training for New Dads
 Normal Pregnancy  High Risk Pregnancy

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Pregnancy complications: GBS +, +RV culture, IUGR affecting care of mother and baby B
Significant health history of parents: Mother  PCOS, endometriosis, history of infertility
Substance use during pregnancy:  Tobacco  Alcohol  Illicit Drugs No use of substances
For each of the previous pregnancies provide the following information (see prenatal record): If first pregnancy (N/A).
TYPE
LENGTH PROBLEMS OF LENGTH COMPLICATIONS
# OF DELIVERY BIRTH
GESTATION PREGNANCY LABOR OF LABOR
PREGNANCY Vaginal or C/S WEIGHT
N/A
3. Laboratory Data: Importance of lab should include discussion on potential effects to M/B
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Lab Patient’s Importance
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Lab Value
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Mother’s blood A- Blood typing of ABO blood group system is done to ensure that moms who need a
type & Rh factor
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transfusion will receive blood that is compatible with her own. The Rh factor is an antigen
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Rh-
that may develop during pregnancy; if the mother is Rh negative but the baby is Rh positive
(due to dad being Rh positive) some of those antigens will cross the placenta and get into
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mom’s bloodstream, causing her to form antibodies against the antigen. In future
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pregnancies these antibodies can cross the placenta and enter the baby’s bloodstream and
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destroy the baby’s red blood cells (if subsequent babies are also Rh positive while mom
remains Rh negative with antibodies) causing a hemolytic disease that is fatal to the baby. If
the mom is Rh negative and baby is Rh positive, the mom will be given an injection of Rh
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immunoglobulin at 28 weeks and after delivery to prevent the Rh positive cells from baby in
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the mother’s bloodstream from triggering the antibody production in the mother to prevent
the hemolytic disease occurring in future pregnancies.
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GBS + Some women carry this bacterium naturally on their skin and it is harmless to mom, but it
can be transmitted to baby and cause complications during pregnancy or serious illness in
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the newborn baby. If the test is negative no action Is needed, but if the test is positive the
mom will be treated with antibiotics during labor to prevent the bacteria from transferring
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to baby.
HBsAg Not in Hepatitis B is a virus that can be transmitted perinatally to baby. It is necessary to screen for
chart this so that babies of moms positive for HBsAg receive the Hepatitis B vaccine and hepatitis
B immune globulin within 12 hours of birth to reduce the risk of transmission.
Rubella Not in A woman infected with the rubella virus during pregnancy can transmit the disease to her
chart fetus, which could cause congenital birth defects as well as miscarriage and stillbirth. If done
before pregnancy and the woman is found to not have immunity she should receive the
vaccination before becoming pregnant. If found the not have immunity while pregnant, the
woman should not receive the vaccination and should avoid people who have or may have
rubella.
VDRL - The mother is screened for syphilis during pregnancy because untreated syphilis is
associated with stillbirth, neonatal death, bone deformities, and neurologic impairment.
When detected, treatment with antibiotics can decrease the proportion of infants with
clinical manifestations of syphilis.
GDM No GDM is screened for because it can lead to hyperglycemia in the fetus, rapid fetal growth
and excessive birth weight, injury to the mother or baby during childbirth and increased risk
of c-section, preterm birth and RDS, and hypoglycemia in the baby after birth as well as
increased risk for developing type 2 diabetes later in life. GDM may cause increased BP,
preeclampsia, and increased risk of developing type 2 diabetes later in life for the mother.
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4. Shift Time Line
Complete the following table for each hour of your observation and for significant events or changes in your patient’s
labor. You may add more rows if needed.
Time Vaginal exam Contraction pattern FHR BOW Narrative of shift (interactions
with patient, patient
Dilatation, Frequency Duration, Rate, Variability, & presence of Intact or positioning, patient
effacement, station Intensity AROM psychosocial considerations
Baseline/periodic changes
Color etc).
0730 3.5, 80%, -1 Frequency: ~Q 12 min Baby 1: 147 Intact Patient and husband arrived, IV
placed in L hand, vaginal exam
Duration: ~30 sec Baby 2: 152
Intensity: mild Moderate; baseline ~140
0845 No vaginal exam Frequency: ~Q 12 min Baby 1: 143 Intact Penicillin (500 million units in
performed 100mPB) & D5LR (125 mL/hour
Duration: ~30 Baby 2: 148 continuous IV) started
0920 No vaginal exam Frequency: ~Q 12 min Baby 1: 142 Intact Pitocin (1 mU/min) started
performed
Duration: ~35 Baby 2: 147
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0950 No vaginal exam Frequency: ~Q 10 min Baby 1: 150 Intact Pitocin increased (2 mU/min)
performed
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Duration: ~35 Baby 2: 140 Patient to birthing ball from bed
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Intensity: mild
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1030 No vaginal exam
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Frequency: ~Q 10 min Baby 1: 143 Intact Pitocin increased (3 mU/min)
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performed
Duration: ~35 Baby 2: 140 Patient up to bathroom, back to
birthing ball
Intensity: mild
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performed
Duration: 35 Baby 2: 150 Patient back to bed from
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birthing ball
Pepcid (20 mg IV push Q12H)
and Tums (500 mg chewable
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tablet Q4H PRN) administered

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performed
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Intensity: mild
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performed
Intensity: mild
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1. What interventions were utilized if labor was not progressing within normal limits? Consider interventions by
the provider, ones ordered by the provider that were implemented by the nurse, and interventions done
autonomously by the nurse.
a. The patient wanted to get up and walking, but because she was having twins she was unable to go very
far until her water broke; the portable toco only measures one baby and baby B was being difficult to get
a reading on even when mom was staying in the same position. The nurse mentioned that once mom’s
water broke they could put an electrode spiral on baby A and baby B could use the portable toco in order
for mom to get up and walking but the water did not break during my time at clinical. Pitocin was started
at 0920 and increased by 1 mU/min every 30 minutes. The patient preferred to sit on the birthing ball to
help ease the pain she felt during contractions, but she eventually went back to bed in order to rest. The
pitocin and activity ad lib were ordered by the provider, assisting the patient to ambulate was
implemented by the nurse, and the nurse autonomously helped to provide comfort to the patient by
having her change positions as needed.
2. What nursing interventions did you and/or the nursing staff utilize to provide support to this patient and her
family? Did you observe or provide caring to the patient and family?
a. The nurse took time to answer and explain everything we were doing throughout the day and
thoroughly answered all questions from mom, dad, and family. I did my best to reassure the mom that
she was in good hands and that we were doing all that we could to provide her comfort and to follow her
birthing plan.
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3. Describe the family support systems. Were they effective? Why?
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a. The mom had her husband present who was very supportive and involved in her care; he provided her
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with emotional support and comfort throughout the day, tried his best to provide distraction and
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comfort during contractions, and held her hand as well as provided soothing touch. The patient’s doula
was also present throughout the day and offered advice and encouragement as needed. The patient’s
mother arrived halfway through the day and seemed to offer a significant amount of comfort. The family
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support system seemed to be effective as the patient was fairly nervous about the possibility of having a
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cesarean section and whether her birth plan would be able to be followed.
4. Describe pain assessment and management strategies utilized throughout the labor/delivery process. Include
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both non-pharmacologic and pharmacologic measures. Were there pain management techniques that were not
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implemented that may have been appropriate for this patient? Why or why not?
a. The patient wished to forego medication to help alleviate pain as long as she could, but we frequently
assessed her pain and attempted to do every nonpharmacological pain management strategy mom was
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willing to try. We applied ice and heat to her back to help ease pain, we assisted mom in standing and
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using the birthing ball as tolerated, and helped her through contractions with breathing. The patient did
not want an epidural, but stated she would much prefer one to a cesarean section in the grand scheme
of things as far as her birth plan was concerned. No pharmacological pain measures were administered
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during my time at clinical, although there were no contraindications to pain meds other than patient
refusal.
5. Discuss safety and security measures implemented throughout the labor/delivery process including the 4th stage
of labor. (Consider general measures as well as unit specific)
a. Safety and security measure implemented throughout labor include, but are not limited to, the use of
the locked unit and requirement of the verification code given to visitors by the patient in order to
obtain access to the unit. The patient did not give birth during the clinical day and I was unable to see
measure implemented during the fourth stage of labor.
6. Discuss the actual (or potential) legal considerations involved in the care of this patient and family (Review legal
tips on page 404, 424 of Lowdermilk text).
a. The patient’s birth plan included refusal of the vitamin K shot, the hepatitis B vaccination, and
erythromycin for the expectant twins. The gender of the twins was a surprise, but if either of the babies
were a boy the patient wished for him to be circumcised. This could become an issue, as the parents
planned to replace the vitamin K shot with oral vitamin K. However, this could present some potential
issue as the oral vitamin K takes longer to take effect so providers may refuse to perform the
circumcision during the normal time of the hospital stay.
7. Reflect upon the care that was provided to this patient and her family. Is there anything that you would do
differently?
a. If I could do the day over I would have attempted to interact with the patient more in order to get a
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better understanding of the patient’s birth plans and wishes, and how they are culturally and/or
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religiously important to the patient. I thought the birth plan was a little odd when I first read through it
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and connected that her religion was listed as Catholic in her chart as well as the patient requesting that
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we do not mention to family or friends that her twins were conceived through IVF; I would take more
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time to connect and attempt to understand my patient if I could do anything differently.
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Labor and Delivery Critical Thinking Assignment Rubric
Include this rubric in your submission
Points Possible Section Comments

earned Points
10 Preparation work
3 Delivery summary
2 Prenatal history
4 Laboratory Data
4 Shift Time Line
2 Labor interventions
2 Nursing interventions/caring
2 Family support systems
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2 Pain management
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4 Safety and security
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2 Legal issues
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2 Communication techniques
1 What would you do differently?

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40 Total
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NURS 352: Labor and Delivery Critical Thinking Assignment

Gravida: 1 Para: 0 TPAL: 0000

Gestational age: 37W 4D  Preterm  Term  Post-term

 SOL (spontaneous onset of labor)

 Episiotomy  Laceration, Degree of laceration__________

Gender of Newborn  Boy  Girl  Surprise! (Unknown gender during labor)

Birth weight: unknown; delivery did not occur while at clinical

Length: unknown; delivery did not occur while at clinical

Apgars: unknown; delivery did not occur while at clinical

Weight gained during pregnancy? 45lb (25-35 lb)

 Normal Pregnancy  High Risk Pregnancy

Significant health history of parents: Mother  PCOS, endometriosis, history of infertility

4. Shift Time Line

Intensity: mild Moderate; baseline ~140

Intensity: mild Moderate; baseline ~140

tablet Q4H PRN) administered

Include this rubric in your submission

Points Possible Section Comments

4 Shift Time Line

2 Family support systems

1 What would you do differently?

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