Case Study: Labor Management
Case Study: Labor Management
Module 3 discussion
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
Part 1: An 18 year old Primigravida presents to Labor And Delivery with what appears to be active labor. Upon questioning, you discover she has received no prenatal care. In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for stress, and denies any support system. The Father of the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins – they were too hard to swallow. She has no idea when her LMP was and she relates always being very irregular. * remember LMP is to ask the first day of the Last Menstrual cycle, not when the bleeding stopped*
What other questions are essential for her safe care?
What lab values do you need to obtain?
What exam findings should you obtain at this time?
What education will you provide for her?
She asks you how long this will take to have the baby – what is your best response?
Part 2: Objective information:
Fetal heart tones are 130, with minimal variability
Vaginal exam is 4 cm/90%effaced/ -1 station
She is complaining of pain – 8/10 on a numerical scale.
An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.
How can you provide non pharmacological comfort to this patient?
What are the pharmacological methods to use?
Without prenatal records or history GBS is unknown. What must you provide?
Contractions are 5 minutes apart and you receive an order to augment labor – what non pharmacological methods can you employ (or ask the MD to provide?)
Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?
Preterm Labor Management
Group B: complete Part 1
Part 1: 25 y/o presents to Labor and Delivery with complaints of uterine cramping and lower back pain. Denies any vaginal bleeding at this time. Has related history of a preterm birth at 32 weeks gestation with her last pregnancy. The baby is 3 years old now and has no developmental issues.
Her current gestational age is 30 weeks.
She is O+ and all other lab values are normal. No noted STI’s.
1. Group Beta Strep is missing from the labs – most often is obtained at 35 – 37 weeks gestation.
2. Without this information it is often determined to treat the patient anyway – presumptively to protect a premature baby from the risk.
3. What other information would you like to ask her?
4. What nursing intervention will you provide?
5. What screening tests are often obtained to help determine her risk for preterm labor.
6. And if it is determined she is in preterm labor what medications may you want to use with a doctors order?
7. Please also give dose, side effects and possible result of the medication.
Group A to complete Part 2 after Part 1 is completed.
Part 2: The patient is now 3cm/100% effaced /-2 station. What is the plan of care for the safety of this patient and her baby? Fetal heart rate is 160 with moderate variability. Contractions are now mild and 15 minutes in frequency.
1. Magnesium Sulfate is used to stop the contractions, and this has been successful.
2. What is the dose you will start with, what is the maintenance dose>
3. Please indicate what nursing interventions are necessary for use with Magnesium Sulfate?