10.12 Spotlight Application

Alejandra, a 28-year-old pregnant female at 39 weeks’ gestation, arrives at the birthing unit of her local hospital accompanied by her partner. She is experiencing regular contractions and reports escalating pain intensity. Alejandra is a gravida 1, para 0. Alejandra describes her pain as intense and continuous, radiating from her lower abdomen to her lower back. She reports a desire for pain relief to cope with the discomfort of labor contractions. Contractions are every three to five minutes and last 60 seconds.

The couple expresses concern about the potential for a prolonged and painful labor process. They have attended childbirth classes and have been walking, breathing, and using counter pressure to assist with the labor pain so far. Alejandra has had a generally uncomplicated prenatal course during this pregnancy, with no significant medical issues. Regular prenatal checkups have shown a healthy fetus with no identified complications.

Her vital signs are as follows: blood pressure–122/78 mm Hg, heart rate–96 bpm, respiratory rate–20 breaths per minute, temperature–98.6° F (37° C), and fetal heart rate–140 bpm, regular rhythm with Category I fetal heart rate pattern. She is 4 cm dilated, 80 effaced, and -1 station.

The nurse creates a nursing care plan:

Nursing Diagnosis: Anxiety related to uncertainty of labor process and pain experience.

Outcome Identification: The client will report reduced anxiety to a manageable level within 1 hour.

Nursing Interventions:

• Establish a therapeutic nurse-client relationship to build trust and provide emotional support.
• Assess the client’s knowledge and understanding of the labor process and address any misconceptions or concerns.
• Provide education on the stages of labor, pain relief options, and relaxation techniques.
• Encourage the client to express her fears and concerns and address them with accurate information.
• Implement nonpharmacologic pain management strategies, such as guided imagery or breathing exercises.
• Involve the client’s support person and encourage them to provide emotional support and reassurance.
• Maintain a calm and peaceful environment in the labor room to promote relaxation.
• Collaborate with the health care team to develop an individualized pain management plan that aligns with the client’s preferences and values.

Evaluation: Within one hour, the client reports a reduction in anxiety and demonstrates understanding of the labor process and pain management options. The client’s partner actively participates in providing emotional support.