Chapter 10

Labor & Delivery Case Study Answers

1. 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.