1 Chapter 10
Labor & Delivery Case Study Answers
1. What information does the nurse need to obtain on her initial assessment?
Fetal Monitoring: Apply fetal monitor to assess the fetus.
Medical History: Pre-existing conditions, past pregnancies, and complications.
Current Pregnancy: Due date, prenatal care, fetal movements.
Labor Progress: Contraction onset, frequency, duration, intensity, membrane status.
Pain Management: Pain description, coping mechanisms, preferences.
Medications/Allergies: Current medications, allergies, prenatal medications.
Support System: Presence of a birthing partner, birth plan preferences.
Physical Exam: Vital signs, cervical status, fetal heart rate.
Psychosocial Assessment: Emotional state, fears, expectations.
Labor Preferences: Pain management and birth position.
Cultural/Religious Factors: Relevant considerations, risk factors.
2. What criteria indicate Denise is in true labor?
Regular contractions every 5 minutes lasting 60 seconds.
Cervical change.
3. Priority nursing care and tests when membranes rupture:
FHR Monitoring: Immediate assessment for distress.
Amniotic Fluid: Assess color, odor, and time of rupture.
Maternal Vitals: Monitor for infection or complications.
Contractions: Evaluate frequency and intensity.
Tests:
AmniSure Test: Detects PAMG-1 in amniotic fluid.
Nitrazine Test: pH test using vaginal fluid.
Ferning Test: Crystallization pattern under a microscope.
4. Interpretation of fetal monitor strip:
Baseline FHR: 130 bpm.
Contraction frequency/duration: Every 2-3 minutes, lasting 45-70 seconds.
Intensity: 50-70 mmHg.
Reassuring pattern: Category I.
5. Denise’s stage and phase of labor:
First stage, active phase.
6. Fetal presentation and position:
Vertex position, right occiput posterior (ROP).
7. Nursing interventions for acute pain:
Breathing techniques, position changes, massage, heat/cold packs.
Hydrotherapy, distraction, education on pain management options.
Emotional support and guidance on relaxation techniques.
8. Considerations for giving fentanyl:
Fetal tolerance, labor stage, and quick delivery risk.
Hold narcotic due to variable decelerations.
9. Nursing actions for variable decelerations:
Reposition, oxygen administration, increase IV fluids.
Encourage controlled breathing, notify provider.
Prepare for potential operative delivery if unresolved.
10. VBAC considerations:
Continuous FHR monitoring, signs of uterine rupture.
IV access, readiness for emergency cesarean.
Pain management support, emotional reassurance.
Collaboration with the healthcare team.
11. Positioning during pushing stage:
Squatting: Opens pelvis for fetal descent.
Side-lying: Conserves energy, reduces perineal tearing.
Hands-and-knees: Alleviates back pain, promotes rotation.
Semi-sitting: Combines comfort and gravity.
Please find answers to the Learning Activity interactive elements within the element.
