CASE STUDY 115

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?
- Is there any pain? Can you tell where pain is?
- Is this your first pregnancy
- Those the water broke?
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?
- Is there any complication to the previous pregnancy?
- When is the last move of the baby?
- Do you have any health problem?
- Does the patient smoke or drink?
3. What assessment should you make to gain further information from DH
- The ultrasound results
- The baby’s position
- Pain assessment
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?
- Continue to monitor the patient check if the patient is in 10 cm dilation, always
prepare the OR for emergency caesarean
5. As part of your assessment, you review the fetal heart strip pictured below. What will
you do?
- Continues to monitor the fetal heart strip if it became abnormal tell the doctor
about the findings
6. List the stages of labor. DH. is in what stage of labor?
 a. 1ST STAGE LABOR – dilation of the cervix
 LATENT PHASE- cervix dilate from 1-3 cm, contraction occurs every 5-30
minutes and 30-45 minutes long, labor can last for 14-20hrs depends on
the previous birth
 ACTIVE PHASE- cervix dilation from 4-7 cm, contraction occurs every 3-5
minutes 45-60 seconds, occurs in 2-5 minutes, can last 4-8hrs
 TRANSITION PHASE- cervix dilated 8-10 cm, intense contraction can occur
every 2-3 minutes lasting 60-90 seconds, the patient experience back
pain
ND
b. 2 STAGE LABOR- the baby is delivering or pushing
c. 3RD STAGE LABOR- full delivery of baby and the placenta is delivered
d. 4th STAGE LABOR- first 1-4 hrs after delivering placenta
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.
 Make the patient walk or move position
 Aromatherapy
 Massage
 Emotional support
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 lasts 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:
 D/C the oxytocin infusion
 Turn onto her left side and elevate legs
 Administer oxygen at 8-10L/min by facemask
 Increase the rate of the maintenance of IV fluid
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- decrease and return of fetal heart rate during the active stage of any
normal during labor. No need for intervention
 VARIABLE- the heart of the baby responds in different times because of cord
compression. Require interventions
 LATE- when the mother has contraction the heart rate of the baby is not
responding, but when the mother is not in contraction the baby heart rate is
moving. Need intervention
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.
- Umbilical cord prolapse is when the cord drops in birth canal ahead the baby instead
behind the baby. This can be dangerous because if cord comes first, it compresses
the umbilical cord and disturb the baby’s oxygen that can damage the brain of the
baby within 4 minutes.
12. What would be done if you noted prolapse?
- Call the doctor
- Prepare for c-section
- Lift the head of the fetus head off the cord to
- Palpate the pulse in the cord
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?
- Dry the baby with warm towel
- Give name band
- Get vital sign
- Weight and height measurement
- Place in the mother’s chest
- Cut the umbilical cord
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?
Naloxone is a drug that are safe to the newborn baby to prevent problems in breathing.
15. D.H. has her episiotomy repaired and the placenta delivered. What are the signs that
the placenta has released from the uterine wall?
- If there are thick bood in the opening of vagina
16. What assessments are important following delivery?
- Monitor the vital signs of the mom and the baby
- Monitor the blood loss
- Breastfeed assessment
 - Mother’s pain level
CASE STUDY OUTCOME
D.H. and her newborn baby boy are taken to the maternity unit where she begins to breastfeed
him.