School of Nursing and Allied Medical

Sciences
Holy Angel University
Angeles City

Name: Santiago, Jaime Louise Date: January 30, 2023

Sibal III, Francisco
Section: NU-201

With your study buddy, work on the case below. Read Module 4 to answer the
questions.
A. A 32-year-old G6P5 patient in labor comes in 7 cm. dilated, 80% effaced at
9 am. Labor monitoring was instituted. Uterus was contracted at 2-3 minutes
frequency, 60 seconds duration, and strong intensity. Fetal heart tones range
from 130 – 140 bpm. Amniotomy revealed clear amniotic fluid.
What time would the nurse expect the patient to be fully dilated if labor
progress is normal? Justify your answer (2pts)
The patient is in her sixth pregnancy, and if her labor progress is
normal, she is in the active stage of labor. By around 11 a.m., it ought to be
completely dilated. Active labor typically lasts two to three and a half hours
(with a wide range considered normal). During labor, your cervix will expand
by 6 to 10 centimeters. Contractions will occur at intervals of three to four
minutes and be more uniformly spaced, strong, and frequent. Your symptoms
will get worse as your labor progresses, though some of them may be
alleviated by labor pain medication like an epidural. You might experience
worsening pain in your back, aching or heavy legs, fatigue, and bloody
discharge.

B. A nullipara was admitted on active labor at 5 cm, ruptured bag of waters,

station -2. After 3 hours of good contractions, 2 – 3 minutes frequency, 60
seconds duration, strong intensity, cervix was 5 cm dilated, station -2.
1. What is the possible condition of the patient? Justify your answer.
(2pts)
After three hours of good contractions, there is most likely no
change in the cervical dilatation, which results in the secondary
dilatation arrest. Because the fetal descent continued after that point
at the -2 station, the descent was stopped. Preterm infants are more
likely than smaller infants and larger infants to experience secondary
arrests. This anomaly occurs less frequently than prolonged
active-phase dilation but more frequently than extended latent-phase
dilation. Due to its connection to higher fetal morbidity and mortality as
well as a significantly increased likelihood of cesarean birth, it has been
categorized as the most severe of dilation disorders.
 School of Nursing and Allied Medical
Sciences
Holy Angel University
Angeles City

2. What are the possible causes of the condition? Justify your answer.
(2pts)
The difference in size between the fetus and the woman's pelvis
during labor is the etiological factor. Each case where this anomaly of
labor is discovered necessitates a thorough investigation of the ratio of
fetal to pelvic maternal size because of the high prevalence of
nonconformity. Inadequate fetal head positioning, excessive anesthetic,
and regional anesthesia are additional etiological factors. In most
cases, inconsistency and two or more of these characteristics coexist.

3. What is the priority nursing diagnosis (give 2)? Justify your

answer.(2pts)
Death Anxiety r/t vague uneasy feeling of discomfort or dread
generated by perceptions of real or imagined threats to one's
existence. Aeb anticipation of pain and suffering.
This nursing diagnosis is critical since the mother is having a
secondary dilatation arrest in a nullipara. Prolonged labor without
progress can be challenging for the mother, especially for nullipara
patients. Due to the mother's circumstances, which include a prolonged
sensation of discomfort, agony, and suffering, this may develop anxiety
and tension, which can also cause complications during birth for the
mother's health and the fetus.
Risk for bleeding r/t susceptible to a decrease in blood volume,
which may compromise health amb pregnancy complication
Since the mother is having a strong contraction and there have
been no changes in the dilation, there could be some complications like
bleeding. Lengthy labor, including a prolonged first stage, may raise the
risk of postpartum in the third stage by producing uterine atony (after
the infant is delivered). When the relaxed myometrium fails to constrict
the uterine blood vessels, this is known as uterine atony.

4. What are the appropriate interventions? Give the rationale. (2pts)

There are many different ways to treat this condition; However,
in order to document cervical dilation, fetal station, presentation, and
position, an initial assessment, and examination of the patient,
including a vaginal examination, are probably required. An intrauterine
monitor should be inserted to determine whether or not uterine
contractions are sufficient. Amniotomy, oxytocin augmentation, and
ambulation are additional options if uterine contractions are deemed
 School of Nursing and Allied Medical
Sciences
Holy Angel University
Angeles City

insufficient. CPD has a strong connection, and many of these patients

will need to be delivered surgically.

C. Immediately after an apparently normal labor and delivery, the mother

suddenly manifested with dyspnea and chest pain. The nurse noticed a gush
of fluid between her legs. Blood pressure likewise dropped sharply from
120/80 mm Hg. Cardiopulmonary arrest rapidly ensued.
1. What is the possible condition of the patient? Justify your answer.
(2pts)
One of the conditions that the mother could be suffering from is
amniotic fluid embolism. This happens when amniotic fluid is forced
into a blood sinus in the mother's uterus that is open. One thing that the
assessment showed was that the woman had a sharp pain in her chest
and was having trouble breathing. This is possible because some of
the signs and symptoms that the nurse assessed are similar to the
condition. such as dyspnea, shortness of breath, a sudden drop in
blood pressure, and fluid being forced between her legs are all signs
that the patient has an amniotic fluid embolism.

2. What is the cause of the condition? (2pts)

Amniotic fluid embolism is hard to figure out, especially if the
patient went through normal labor and delivery. However, there is a
good chance that the patient's condition began when the membrane
ruptured or when the placenta partially separated, triggering an
immune response or hypersensitivity reaction that caused an
anaphylactic response. The use of oxytocin, abruptio placentae, and
hydramnios are all factors that may increase the likelihood of this
condition occurring. Furthermore, healthcare providers divide amniotic
fluid embolism into two stages: the hemorrhagic phase and the rapid
respiratory failure and cardiac arrest phase. That is why, when this
condition occurs, healthcare providers should provide immediate
treatment.

3. What are your interventions? Give rationale. (2pts)

● Since the patient had trouble breathing, providing oxygen should be
done through a tracheal tube or through a machine if a face mask is
not enough.
● Because of the hemorrhagic phase of amniotic fluid embolism,
providing multiple blood, plasma, and platelet transfusions are needed.
 School of Nursing and Allied Medical
Sciences
Holy Angel University
Angeles City

● If bleeding is not stopping, prepare equipment and instruments for a

possible hysterectomy.
● Perform CPR to help the heart pump blood throughout the body
because death can happen in minutes.

References:

Colleen de Bellefonds, Contributing Editor/Writer. (2022, June 21). What Are

the Stages of Labor and How Long Does Labor Last? What to Expect.
https://www.whattoexpect.com/pregnancy/labor-and-delivery/childbirth-
stages/three-phases-of-labor.aspx

Drennan, K. J., Blackwell, S., MD, & Sokol, R. J., MD. (n.d.). Abnormal Labor:
Diagnosis and Management. GLOWM.
https://www.glowm.com/section-view/heading/Abnormal+Labor:+Diagn
osis+and+Management/item/132