Misamis University Graduate School

Master in Nursing/Master of Arts in Nursing

213-INTENSIVE PRACTICUM 2
Second Semester, S.Y. 2022-2023

A CASE STUDY OF FETAL DISTRESS

(Prolong second stage of Labor)

STUDENT:
PROFESSOR:

PATIENT’S DEMOGRAPHIC DATA

 PATIENTS INITIAL:
 AGE:
 ADDRESS:

 OCCUPATION:
 DATE OF ADMISSION:

BRIEF HISTORY OF PRESENT ILLNESS/ OB HISTORY

CHIEF COMPLAINT’S Prior to admission, patient complaints onset of labor

pain.

MEDICAL DIAGNOSIS
 ADMITTING DIAGNOSIS -G1P0 PU 42 5/7 weeks aog by lmp, cephalic in active
labor

 FINAL DIAGNOSIS -G1P1 (1001) Pregnancy uterine delivered via primary

low transverse cesarian section, extracted to a live,
term, cephalic baby girl with apgar score 6-7,
prolonged second stage of labor, thickly meconium
stained.

OBSTETRIC HISTORY Gravida-1

LMP: 7/10/2022 EDD:5/17/2023
Pregnancy uterine 39 5/7 weeks aog by lmp

PHYSICAL EXAMINATION GENERAL SURVEY: Alert, Awake

VITAL SIGNS: BP:120/80mmHg; HR:80bpm;
RR:18cpm; Temperature: 36.8 °C
ABDOMEN: Gravid FH 28cm, FHT: 142 RLQ
 GU/IE: IE 4cm (+) intact bow
CHEST AND LUNGS: Clear breath sounds

LABORATORY:
HEMATOLOGY
WBC 11.34
RBC 4.22
HEMOGLOBIN 11.7
HEMATOCRIT 34.1
PLATELET 405

URINALYSIS
COLOR: YELLOW PUS CELLS: 1-2
APPEARANCE: CLOUDY RBC:11-18
BLOOD:2+ BACTERIA: Rare

FETAL DISTRESS

Fetal distress is a sign that your baby is not well. It happens when the baby isn’t receiving
enough oxygen through the placenta.

Fetal distress can sometimes happen during pregnancy, but it’s more common during labour.

How is fetal distress diagnosed?

Fetal distress is diagnosed by monitoring the baby’s heart rate. A slow heart rate, or unusual
patterns in the heart rate, may signal fetal distress.

Your doctor or midwife might pick up signs of fetal distress as they listen to your baby’s heart
during pregnancy.

Your baby’s movements are a sign that your baby is well. A change in your baby’s movements
may be a sign of fetal distress.

Another sign of possible fetal distress is meconium in the amniotic fluid. Let
your doctor or midwife know right away if your notice your amniotic fluid is green or brown,
since this could signal the presence of meconium (newborn poo, that your baby may pass while
still in your uterus if they are distressed).

Does fetal distress have any lasting effects?

Babies who experience fetal distress are at greater risk of complications after birth. Prolonged
lack of oxygen during pregnancy and birth can lead to serious complications for the baby, if it is
not noticed and managed early. Complications may include brain injury, cerebral palsy and
even stillbirth.

Fetal distress may require an assisted birth or caesarean section. While these interventions are
safe, they are associated with their own set of risks and complications. Having fetal distress in
one pregnancy doesn’t mean you will necessarily experience fetal distress in your next
pregnancy. Every pregnancy is different. If you’re worried about future pregnancies, it can help
to talk to your doctor or midwife so they can explain what happened before and during the birth.

What causes fetal distress?

Fetal distress may occur when the baby doesn’t receive enough oxygen because of problems with
the placenta (such as placental abruption or placental insufficiency) or problems with the
umbilical cord (such as cord prolapse).

It is more common if you are overdue, have pregnancy complications or when there are
other complications during labour. Sometimes it happens because the contractions are too strong
or too close together.

ETHIOLOGY
REFERRENCE PATIENT
The primary etiology of a late declaration is  Prolong second stage of labor (more
found to be uteroplacental insufficiency. than 24 hours)
Decreased blood flow to the placenta causes a  Meconium stained
reduced amount of blood and oxygen to the
fetus

Your baby is more likely to experience fetal

distress if:

 you are obese

 you have high blood pressure in
pregnancy or pre-eclampsia
 you have a chronic disease, such as
diabetes, kidney disease
or cholestasis(a condition that affects
the liver in pregnancy)
 you have a multiple pregnancy
 your baby has fetal growth restriction
PATHOPHYSIOLOGY

MATERNAL STATUS
Prolong second stage of labor

Placenta can’t no longer maintained

a healthy environment

Inadequate supply of oxygen to the fetus

Anearobic Respiration
Relaxation of anal
sphincter increased
1.) Parasymphathetic gastrointestinal peristalsis
stimulation

Passage of meconium
2.) Hydrogen ions depress at
SA nodes Bradycardia and
deceleration

Reduce gases of the fetal blood

-Accumulation of CO2
-Respiratory Acidosis

Accumulation of lactic acid and hydrogen Abnormal fetal heart

ions and deficiency of bicarbonate ions patterns

Metabolic Acidosis

How is fetal distress FETAL DISTRESS managed?

There are a few ways that fetal distress may be managed. Your doctor will assess your situation
and discuss with you the best management option in your situation.

If you are not in labour

 Depending on your situation, your doctor or midwife may recommend interventions such
as medicines or intravenous fluids. If these interventions do not help, your doctor may
recommend an emergency caesarean section so you birth your baby quickly.

If you are in labour

 You will usually be given you oxygen and fluids. Sometimes changing position, such as
turning onto your side, can reduce the baby’s distress.
 You may be given medicine to slow down the contractions. If you had medicines to speed
up labour, these may be stopped if there are signs of fetal distress.
 Sometimes, a baby in fetal distress needs to be born quickly. Your doctor may
recommend an assisted (or instrumental) birth or you might need to have an emergency
caesarean.
 Most of the time, there will be time to discuss your options with your doctor and/or
midwife. However, in some emergency situations, your doctor or midwife will need to
act quickly. If there are any medical interventions you object to, such as receiving a blood
donation, it’s a good idea to make sure that your doctor and/or midwife are aware of this
when you arrive at the hospital.

NURSING RESPONSIBILITIES
Before Delivery
 Monitor patients Fetal heart tone.
 Checked the color, odor and any signs of ruptures amniotic fluid.
 Maintained oxygen supplementation of the mother.
After Delivery (Caesarean Section)
 MOTHER
-Monitored for any signs of profused vaginal bleeding
-Maintained Uterine contractility

 BABY
-Maintained oxygen supplementation.
-Kept thermoregulated.
-Checked for any signs of newborn complication due to fetal distress.

NURSING CARE PLAN

 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective: Activity After 8 hours of -Assessed maternal and
“Dugay-dugay intolerance nursing intervention fetal status. After 8 hours
gyud ko gabati” related to the patient will be able series of nursing
as verbalized by muscle or to identified techniques -Oxygen supplementation interventions,
the patient. cellular to enhance activity administered to support the goals are met,
sensitivity intolerance. fetus. patient was able to
Objective: delivered baby
-Facial grimace -Apply external, internal safely.
noted during and fetal monitoring.
labor.
- Continued -Carried out orders for
uterine caesarean section.
contraction.
-Irritability
noted.
-Greenish bow
upon internal
examination
noted.
-Fht: 142bpm
DRUGS STUDY:
GENERIC NAME KETOROLAC TROMETHAMINE
CLASSIFICATION ANTI-PYRETIC

DOSSAGE 30mg
ROUTE IVTT
FREQUENCY EVERY 6 HOURS IF NECCESSARY

MECHANISM OF ACTION Anti- inflammatory analgesic activity, inhibits

prostaglandins and leukotriene synthesis.

INDICATIONS Short term management of pain (up to 5 days)

CONTRAINDICATIONS Contraindicated with significant renal impairment, aspirin

allergy, recent GI bleed or perforation. Use cautiously with
impaired hearing, allergies and hepatic condition.

SIDE EFFECT CNS: Headache, dizziness, somnolence, insomnia, fatigue

and ophthalmologic effects.

NURSING 1. be aware that patient may be at risk for CV events, GI

RESPONSIBILITIES bleeding, renal toxicity, monitor accordingly.
2. Keep emergency equipment readily available at time of
initial dose, in case of severe hypersensitivity reaction.

3. Protect drug from light.

4. Administer every 6 hours to maintain serum levels and

control pain.
GENERIC NAME CEFUROXIME
CLASSIFICATION ANTIBIOTIC
DOSSAGE 750mg
ROUTE IVTT
FREQUENCY EVERY 8 HOURS
MECHANISM OF ACTION Bind to bacterial cell wall membrane causing cell death

INDICATIONS for surgical prophylaxis, reducing or eliminating

infection, treatment for gynecologic infections, lower
respiratory tract infections, skin and soft tissue, urinary
tract infections.

CONTRAINDICATIONS Hypersensitivity to cephalosporin and related antibiotics;

category B, lactation.

SIDE EFFECT GI: diarrhea, nausea, unpleasant taste of the mouth.

SKIN: rash, pruritus, urticarial
EENT: Stuffy nose
CNS: Seizures

NURSING 1.) Asses patient for signs and symptoms of infection

RESPONSIBILITIES prior to and throughout therapy.

2.) Before initiating therapy, obtain a history to

determine previous use of and reactions to
penicillin. Persons with a negative sensitivity may
still have an allergic response.

3.) Observe patient for signs and symptoms of

anaphylaxis (rash, pruritus, laryngeal edema,
wheezing). Discontinue the drug an notify
physician.

4.) Instruct patient to report signs of hypersensitivity

GENERIC NAME RANITIDINE

CLASSIFICATION ANTI-ULCER
HISTAMINEH2ANTAGONIST
DOSSAGE 50mg
ROUTE IVTT
FREQUENCY EVERY 8 HOURS

MECHANISM OF ACTION Inhibits action of histamine at the H2 receptor site located

primarily in gastric parietal cells, resulting in inhibition of
gastric acid and secretion.

Has some anti-bacterial action against H. pyloric.

INDICATIONS This drug is used alone or with concomitant antacids for the
following conditions: short-term treatment of active
duodenal ulcer, treating gastric acid hypersecretion due to
Zollinger-Ellison syndrome, and other conditions that may
pathologically raise gastric acid levels. It also used in the
short-term treatment of active benign gastric ulcers and
maintenance therapy of gastric ulcers at a reduced dose.

CONTRAINDICATIONS Hypersensitivity, cross- sensitivity may occur some oral

liquid contain alcohol and should be avoided in patients
with known intolerance.

ADVERSE EFFECT GI: Nausea, Abdominal Pain, Diarrhea, Constipation

SKIN: Rash

CNS: Drowsiness, Dizziness, Headache, Insomnia

CV: Bradycardia

NURSING 1.) Instruct patient not to take new medication without

RESPONSIBILITIES consulting physician.
2.) Allow 1 hour between any other antacid and ranitidine.

3.(Monitor creatinine clearance if renal dysfunction is

present.

4.) Be alert for early signs of hepatoxicity.

 DISCHARGE PLANNING

HEALTH TEACHING
 Instructed mother to properly breastfeed the baby with precaution.
 Hand hygiene is being emphasized to limit cross contamination.
 Newborn care properly emphasized.
TREATMENT
 The primary care provider should evaluate the infant who has taken antibiotics
within 1week of discharged from the hospital.
 Evaluate the infant for superinfection before discharged.
 Retinal examination – The joint commission recommends that the infants who
receive oxygen therapy should receive follow up retinal examination.
 Vaccinations- Emphasized to mothers the importance of neonatal vaccinations.