Case Study for NSG 250
Scenario
D.H. comes the labor and delivery unit having contractions and feeling somewhat extremely uncomfortable and doubling over with contraction pain. She says she was shopping in the mall with her friend and “It was really bad! I could barely walk to the car!” A nurse takes her to the intake room, provides privacy, has her change into a gown, and prepares for assessment. ALL Answers should have evidenced based rationale.
- D.H. has contractions 2 minutes apart lasting 45 seconds. This is her fifth pregnancy at 38 weeks gestation. She has two children 8 and 3 at home both term deliveries, had one miscarriage at 12 weeks gestation. The membranes are intact at this time. A nurse should most appropriately ask for what information before doing a vaginal exam?
- What is the GTPAL based upon her maternal history?
- What assessments should be done to gain further information from D.H?
- The digital vaginal exam reveals 80% effacement, 8 cm dilated and 0 station. The fetal heart rate (FHR) is 150 beats/min and moderate variability. The client is admitted to a labor and delivery room on the unit. What nursing measures should be done at this time?
- Review the stages of labor. What stage is D.H. in at this time based on the above information?
- D.H.is assessed with external electronic toco and fetus is assessed with an external electronic fetal monitorthroughout labor. What abnormalities should a nurse assess for?
- The nurse notes the following pattern on the external fetal monitoring strip. What are the most appropriate nursing interventions at this time?
- The client delivers 45 minutes later. D.H. has a 2nd degree episiotomy to allow more room for the infant to descend and delivers an 6lb 8 oz female infant.What is involved in the immediate care of the newborn?
- D.H. has her episiotomy repaired and the placenta delivered. Describe the signs that the placenta has released from the uterine wall?
- Write the priority nursing diagnosis for D.H at this timein appropriate format with all data to support.
- What is the goal for this diagnosis? Include three interventions that will resolve or relieve the problems with rationale. What medication and method of delivery can be anticipated at this time?
- What assessments are important for D.H. immediately following delivery?
- The infant at 1 hour of age is without respiratory distress and has been assessed with the New Ballard Score. The infant is determined to be SGA. What type of care would a nurse plan to care for this infant.
- The mother is breastfeeding the infant every 2-3 hours for the past 24 hours. The nurse assesses the feeding and notes that the mother winces each time the baby latches on and assesses as erythema, sore area on the left nipple. What is the most likely cause of this?
- How would a nurse assist the mother and infant to correct this problem?
- The infant will be discharged home with the mother. Write one goal for the newborn based upon the information in question 15.
