Ilana Rabinowitz

SUNY Delhi
May 4, 2019
 Evolving case study
 Divided into groups of 4-5
 Pieces of information will be provided
 Questions asked
 Submit answers
 More information provided
 Questions asked
 Submit answers
 Group grade
 10% of course grade
 Student was able to communicate and educate the patient in an
appropriate, respectful and comforting manner. 10%
 Student was able to assess the fetal heart monitor appropriately
and identify the correct interventions to take. 10%
 Student was able to identify necessary steps during pre-op. 10%
 Student was able to identify necessary steps for circulating nurse
intra op. 10%
 Student was able to identify necessary steps post-op. 10%
 Student was able to identify signs and symptoms of
complications. 15%
 Student was able to identify risk factors. 15%
 Student was able to assess the needs of the patient and verbalize
concerns to doctor. 10%
 Student was able to assess the need for further patient education
and consults. 10%
 A patient walks into the Labor and Delivery
unit at 40 weeks pregnant for a scheduled c-
section. The patient registers and is admitted
into the pre-op area. As the registered nurse
assigned to this patient, please explain what
steps you will take in the pre-op area prior to
entering the OR. What equipment will you
need? What questions will you ask your
patient?
 While obtaining your pre-op
information, you see this on the fetal
heart monitor:
 After your interventions, your strip now looks
like this:
 After obtaining your health history, you learn that
your patient is 38 years old and has a BMI of 29.
She has had 2 previous C-sections at a different
facility- the first was due to a breech presentation
and the second was a repeat c-section. Her
children are 2 and 3 years old.
 She states “ They gave me some medicine or
something the last time because I was bleeding a
lot, but I don’t know what it was”.
 She also reports having an allergy to Penicillin but
isn’t really sure what happens when she takes it-
she thinks it gives her a rash.
 What are some things that you would be
concerned about at this time?
 Are there any special precautions or steps you
will take based on this information?
 Are there any suggestions or recommendations
you would make for the doctor?
 Before going into the operating room, the patient
expresses being very nervous. She says “even
though the doctors told me all of this already, can
you just explain to me what is going to happen in
there, I’m really scared something is going to go
wrong”.

 Please explain what signs and symptoms of

potential complications you would be looking for
during the procedure
 Then describe how you would respond to your
patient at this time.
 You are now ready to go into the operating
room with patient as the circulating nurse.

 Please describe what you will be doing after

you enter the OR.
 When you get ready to start the time out- the
doctor says “yea yea, this is Mrs. Smith, c-
section, let’s get this thing started already”.

 How would you respond? And why?

 The baby is delivered without any
complications. You assess the baby, everything
appears normal. You report this to the mother.
The mother appears to be well a this time but
states she’s starting to feel a little tired.
 You chart your assessments in the electronic
medical record.
 During the procedure, the scrub tech requests 2
extra sets of lap pads.

 What might this indicate to you?

 What might you anticipate needing next? Any
additional equipment? Medications? Etc.
 The bleeding appears to be under control at
this time after the patient received an extra
dose of IV Pitocin. You assist the team with
cleaning the patient up and transporting her to
the recovery room.

 What are the first steps you will take when

entering the recovery room?
 After about 45 minutes in the recovery room,
the patient’s vitals are:
 B/P 80/50
 HR 125
 Temp 96.0 F
 Pulse ox 98%

 She said she is starting to feel a little weak and

tired.
 What steps would you take next?
 What do you think is going on?
 When performing your fundal checks you
assess that it is firm and at the level of the
umbilicus.
 Surgical incision site is clean and dry.
 When you assess the lochia- you notice there is
a moderate amount with several golf ball sized
clots.

 What would you do next?

 What do you anticipate the doctor ordering?
 After receiving a dose of Methergine and being
placed on a Bair hugger, the patient’s vitals are
now:
 B/P 105/80
 HR 85
 Temp 98.5
 Pulse ox 99%
 Fundus remains firm. Surgical incision site is
clean and dry. Lochia light with no clots.
 The patient states she feels much better now
and thanks you for all your help.
 The patient expresses feeling nervous about
being discharged home since she has two small
children at home. She said she wants to try to
breastfeed so she can save money on formula.
She didn’t breastfeed her first two children and
is worried she won’t know what to do.
 You notice that she does not have any family or
support team with her since she came in. She
said her husband is working and her mother is
watching the kids.
 What type of education would you provide to
your patient?
 Are there any consults you would recommend
ordering?