CASE STUDY #1: LABOR AND DELIVERY

:SITUATION

Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated
that she had been having contractions at 7 to 10 minute intervals since 4 p.m. They
lasted 30 seconds. She also stated that she had been having "a lot of false labor" and
hoped that this was "the real thing". Her membranes were intact. Mrs. M.'s temperature,
pulse and respirations were normal and her blood pressure was 124/80. The fetal heart
tones were 134 and regular. The nurse examined Mrs. M. and found that the baby's
head was at +1 station, and the cervix was 4 cm. dilated and 80 percent effaced. She
reported her findings to the doctor and he ordered Demerol 50 mg. with Phenergan 25
.mg. to be given intravenously when needed

Do you think Mrs. M. is in false labor? Give reasons for your answer. I do not think .1

she is in false labor because she said she knew she had false labor before, and now

.she is having timed contractions

As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that .2

you would do after this occurs? Why? First thing to do is to assess the fetal heart

.rate to ensure that there’s no harm to the umbilical cord

After her membranes ruptured, her contractions began coming every 4 minutes and .3

lasted 45 to 55 seconds. They were moderately strong. Why is it important for Mrs.

M. to relax during her contractions? How can you help her to relax? It is important to

remain relaxed because it can decrease the intensity of the pain, and calm the

mother during the process. The women can have the lights dimmed or listen to

.music to help soothe the pain

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 When do you think Mrs. M. should be given the medication ordered by the doctor? .4

What safety measures should be taken at the time the medication is given? What

observations should be made after it is given? Why? What observations would you

report to the doctor? The women should get the medication during the first stage of

labor, as well as the mother should have her BP monitored and fall precautions in

order. The fetal heart rate should be monitored as well to ensure no severe decline.

In the case of respiratory depression or severe hypotension, it should be reported to

.the doctor

How would you know that Mrs. M. has entered the transition phase? She wants it to .5

.be the real thing, not fake labor

A vaginal exam revealed that Mrs. M. is complete and +2. What should be the .6

nursing interventions at this time? The need to help the mother with breathing

exercise, and distractions. Need to monitor maternal and fetal blood pressure, and

.pulse to ensure no problems arise

The doctor gave her a pudendal block and did a midline episiotomy. At 8:05 p.m. Mrs.

M. gave birth to a 7 lbs., 5 oz. (3.317 gm.) boy in the L.O.A. position. The nurse put

medicine in the baby's eyes and placed an identifying bracelet on his right wrist and

ankle. A matching bracelet was placed on the mother's wrist. The baby was shown

to his mother and then taken to the newborn nursery. At 8:08 p.m. the placenta was

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 .expelled

Why is the medicine put in the baby's eyes? The medicine is put on the baby’s eyes .7

.to prevent the baby from getting pink eye

Why is it important to put identification on the baby in the delivery room? It is .8

important so when the babies are put in the nursery, they will be able to tell the

.difference between the babies, and who’s is who’s

What care should Mrs. M. receive before she is transferred to the recovery room. .9

Why? Before she is transferred to the recovery room, she would be assessed for

.extensive bleeding, and heart rate to ensure she is not hemorrhaging

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