Comprehensive case study

Scenano 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. 1. D.H. at 38 weeks gestation started contracting 2 hours ago and has contractions 2 minutes apart lasting 45 seconds. This is her fifth pregnancy. She has two children 8 and 3 at home both term deliveries. The membranes are intact at this time. A nurse should most appropriately ask for what information before doing a vaginal exam? 2. What is the GTPAL based upon her maternal history? 3. What assessments should be done to gain further information from D.H? 4. 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? 4a. Write an SBAR to call the physician at this time. 5. Review the stages of labor. What stage is D.H. in at this time based on the above information? 6. D.H. is assessed with external electronic toco and fetus is assessed with an external electronic fetal monitor throughout labor. What abnormalities should a nurse assess for? 7. The nurse notes the following pattern on the external fetal monitoring strip. 7a. Describe the tracing • FHR • Variability • Periodic/Episodic Changes • Contractions o Frequency o Duration 7b. What are the most appropriate nursing interventions at this time? 8. The client delivers 45 minutes later. D.H. has a perinea! laceration and delivers an 6 lb 8 oz female infant. Describe the immediate care of the newborn? 9. D.H. has her laceration repaired and the placenta delivered intact. a. Describe the signs that the placenta has released from the uterine wall? b. There is 500mL of lactated ringers in her IV fluid bag. What medication and dose would a nurse expect to add to the bag and what is the rate? 10. Write the priority nursing diagnosis for D.H at this time in appropriate format with all data to support. 11. Plan care for D.H. based upon the priority NDx a. What is the goal for this diagnosis? b. Include three interventions that will resolve or relieve the problems with rationale. c. What medication and method of delivery can be anticipated at this time? 12. What assessments are important for D.H. immediately following delivery? 13. 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 plan of care would a nurse develop to best care for this infant? 14. 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 an erythema, sore area on the left nipple. What is the most likely cause of this? 15. How would a nurse assist the mother and infant to correct this problem? 16 The infant will be discharged home with the mother. Write one goal for the newborn based upon the information in question 15.