Essentials of Maternity, Newborn, and Women’s Health Nursing
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)
A. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery.
B. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.
C. 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 an Essentials of Maternity, Newborn, and Women’s Health Nursingd her date of conception is limited to one possible day. Her physician gives her an EDC of March 28th. 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 14th 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.
Chapter 22: Nursing Management of the Postpartum Woman at Risk
1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6) Essentials of Maternity, Newborn, and Women’s Health Nursing
- What are the “four T’s” that need to be assessed in a possible case of postpartum hemorrhage?
- Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?
2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)
- Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
- What additional questions do you want to ask her to try to ascertain the cause of her fever?
3. Describe the care required to treat each of these infections.
Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions
1. On the evening shift in the special care nursery, you are paged to delivery room 5. When you arrive, the labor nurse says the baby has been stuck in the birth canal for a while, and the fetal heart tones are down. They use the vacuum suction to assist delivery. The doctor gets the baby out and places the infant on the radiant warmer. You are the resuscitating nurse for the infant, and you observe the following: the infant is limp, pale, gasping, has poor tone, and the heart rate is 101. (Learning Objective 1) Essentials of Maternity, Newborn, and Women’s Health Nursing
- What are your first actions to aid in this infant’s recovery?
- What Apgar score would you assign at 1 minute with these results? Explain the score for each category.
2. Tammi is an 18-year-old single mother who delivered a full-term infant 3 days ago. The father is not involved, and Tammi’s aunt is her support person. The infant is very fussy in the nursery, with mild tremors noted. Tammi is having a hard time feeding her baby, the baby spits up a lot and he does not console easily. The physician has been called to assess the infant. (Learning Objective 7)
- What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
- What is the acronym of the tool used in assessing the infant’s condition, and what are the top three substances used that can cause this condition?
- Name what measures are used to test for this condition and on whom you perform the test.
3. Mandy just gave birth vaginally to her first child. Mandy and James had attended prenatal classes and had a natural childbirth. They were totally unprepared to see that baby “Rose” has a severe left-sided unilateral cleft lip and cleft palate. James is having a hard time with this and just keeps staring at the baby. Mandy begins to cry and states “I thought I was going to breast-feed my baby and now it’s impossible.” (Learning Objectives 12, 14, and 15)
- A. Discuss the implications for bottle feeding and breast-feeding a baby with a unilateral cleft lip. Is it possible for Mandy to breast-feed Rose? Essentials of Maternity, Newborn, and Women’s Health Nursing
- B. What is involved in the surgical correction of the defect? When can she eventually have a “normal” mouth and facial features?
- C. What other problems may develop for Rose since she has this type of defect?
D. How can you assist the family bond with Rose?
Chapter 13: Labor and Birth Process
Emily, age 32, has an obstetrical history of G1, T0, P0, A0, 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. Essentials of Maternity, Newborn, and Women’s Health Nursing
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.
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Ten minutes after the vaginal exam by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)
a. 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?
The questions include asking whether she is in pain, specifically whether or not she has low back pain. The nurse might also ask whether there is vaginal bleeding. The prenatal information would be the intensity and frequency of contractions. Other questions would be “When did the contractions begin?” “Where do you feel the pain…back or belly?” “Does rest or drinking fluid help the pain?” “Fetal movements?” Essentials of Maternity, Newborn, and Women’s Health Nursing
b. 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?
If the cervix is 3 cm dilated, 40 % effaced, Emily is in active labor. During phase 1, the cervix begs to dilate and continues to thin for the delivery. “Vitals are stable and FHT are reassuring meaning the fetus is not in any distress” (Oktay et al, 2016). The physiological changes include the pressure on pelvis, increase in pain and regular uterine contractions with concomitant cervical dilation and effacement while the psychological changes include increase in fear, distress, and the need for hydration and food although appetite is often suppressed. The appropriate activities would be to have Emily walk around to help in moving labor. Emily can participate in activities that involve walking. Essentials of Maternity, Newborn, and Women’s Health Nursing
c. Describe 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.”
The nursing interventions are to assess the FHR and determine the color and odor of amniotic fluid in case the membranes ruptured. Vital signs should be assessed and nearness to birth should also be determined by evaluating cervical dilation and contractions. The time of ROM is at the onset of labor. The healthcare provider should be notified of the rupture of membranes.
2. Diane, age 22, has been in labor for 8 hours. Her cervical exam 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) Essentials of Maternity, Newborn, and Women’s Health Nursing
1. 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.
The cause of slow labor progress is the Passenger. The malposition of fetus causes it. The fetal position is the cephalic posterior position.
You have to identify the fetal positon that causes back pain and slow progress.
“The fetus is the ‘passenger travelling down the birth canal” (Subramaniam et al, 2019). The low progress may be as a result of the fetal head being too large in addition to the mispositioning. There might be exertion of pressure on the mother’s sacral backbone which causes the back pain and poor cervical dilatation. Essentials of Maternity, Newborn, and Women’s Health Nursing
0. What strategies may the nurse implement to assist Diane in progressing in her labor?
The strategies are:
a. Telling her to squat
b. Asking her to sit on the birth ball
c. Use of the miles circuit technique
d. Conducting abdominal lift
e. Asking Diane to balance on knees and hands on a bed to help adjust fetal position. Essentials of Maternity, Newborn, and Women’s Health Nursing
It is good to encourage Diane that she will be able to bear the pain of delivery. Diane should also remind on the birth plan.
REFERENCES
Oktay, K., Bedoschi, G., Pacheco, F., Turan, V., & Emirdar, V. (2016). First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. American journal of obstetrics and gynecology, 214(1), 94-e1.
Subramaniam, A., Tita, A. T., & Rouse, D. J. (2019). Obstetric Management of Labor and Vaginal Delivery. Chestnut’s Obstetric Anesthesia E-Book, 393 Essentials of Maternity, Newborn, and Women’s Health Nursing.
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