Chapter 10

Labor & Delivery Case Study

Answers

1. The information the nurse needs to obtain on her initial assessment includes the following:
   • Fetal Monitoring: Apply fetal monitor to assess the fetus.
   • Medical History: Preexisting 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 and 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 and risk factors.
2. Criteria that indicate Denise is in true labor include regular contractions every 5 minutes lasting 60 seconds and cervical change.
3. The priority nursing cares when Denise’s water breaks include the following:
   • FHR Monitoring: Perform 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 used to confirm a rupture of membranes are as follows:

   • AmniSure Test: Detects PAMG-1 in amniotic fluid.
   • Nitrazine Test: pH test using vaginal fluid.
   • Ferning Test: Crystallization pattern under a microscope.
4. An interpretation of the fetal monitor strip reveals the following:
   • 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 is in the first stage of labor and in the active phase.
6. The fetal presentation is right occiput posterior (ROP), and the position is the vertex position.
7. Nursing interventions for acute pain include the following:
   • 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 include fetal tolerance, labor stage, and quick delivery risk. The narcotic should be held due to variable decelerations.
9. Nursing actions for variable decelerations include the following:
   • Reposition, oxygen administration, and increase IV fluids.
   • Encourage controlled breathing and notify provider.
   • Prepare for potential operative delivery if unresolved.
10. VBAC considerations are as follows:
    • Continuous FHR monitoring, signs of uterine rupture.
    • IV access and readiness for emergency cesarean.
    • Pain management support and emotional reassurance.
    • Collaboration with the health care team.
11. The nurse should assist Denise with the following positioning during the pushing stage of labor:
    • Squatting: Opens pelvis for fetal descent.
    • Side-lying: Conserves energy and reduces perineal tearing.
    • Hands-and-knees: Alleviates back pain and promotes rotation.
    • Semi-sitting: Combines comfort and gravity.

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