Nursing Case Study
Chapter 13, Labor and Birth Process
1. Emily, age 32, has an obstetrical history of G1, T0, P0, A0, and L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.
The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.
Ten minutes after the vaginal examination by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)
- What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?
- Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? Why?
- What are the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants”?
2. Diane, age 22, has been in labor for 8 hours. Her cervical examination reveals she is 3 cm, 30% effaced, and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)
- Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.
- What strategies may the nurse implement to assist Diane in progressing in her labor?
Chapter 14, Nursing Management During Labor and Birth
1.Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical examination. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 5, and 8)
- Based on the vaginal assessment, what is the stage of labor and what are the appropriate nursing interventions for this stage of labor?
- Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor?
- Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?
2.Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced, and +2 station.She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended.(Learning Objectives 3 and 4)
A.What is happening to Emily’s baby at this point in time?What does this mean?
B.What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?
Chapter 21, Nursing Management of Labor and Birth at Risk
1.Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC.(Learning Objective 9)
- In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery.
- Laura can’t understand why more women don’t want to try a VBAC delivery.Discuss the possible reasons for this.
- Describe the management of care for a woman attempting a VBAC delivery.
2.Carol, age 17, is pregnant with her first child.Her menstrual dates are accurate and her date of conception is limited to one possible day.Her physician gives her an EDC of March 28. Carol has gone past her due date and refuses to have her labor induced.Carol states, “My grandmother says that the baby will come when it is good and ready.”It is now April 14 and Carol is at 42 3/7 weeks’ gestation. She calls the office and reports that she is having a significant lower backache and she just passed “a glob of bloody mucus” from her vagina.(Learning Objective 5)
A.Discuss the risks a prolonged pregnancy places on Carol.
B.What risks are there for Carol’s unborn baby?
C.Describe the nursing care required for women in labor with a prolonged pregnancy.