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# 1 MANAGEMENT OF PATIENT IN LABOR Beth is a 28-year-old gravida 1,…
# 1 MANAGEMENT OF PATIENT IN LABOR
Beth is a 28-year-old gravida 1, para 0 patient, who was admitted 1 hour ago. Beth’s cervix is 3 cm dilated and 100% effaced, the station is -2, and her membranes are intact. Contractions occur every 3 minutes, last 40 to 50 seconds, and are of moderate intensity. The fetal heart rate averages 135 to 145 beats per minute (bpm) and has a Category I pattern. Beth reports that constant back pain is annoying; however, she feels that she can cope with it at this time. Beth and her husband Sam attended prepared childbirth classes and are using the breathing techniques they learned.
Questions
a. At what stage of labor is Beth?
b. Explain to Beth her vaginal exam and her progress.
c. Identify Beth’s problems at this time.
d. Using nursing process, formulate a nursing care plan for Beth.
e. At this time, what methods for pain management are most appropriate to suggest, nonpharmacologic or pharmacologic?
#2 NURSING CARE OF A POST-PARTUM PATIENT
Jenny, 27 years old, delivered her fourth baby vaginally after a normal pregnancy, labor, and delivery. Baby Cooper weighs 3228 g (8 lb.) and is 55.9 cm (22 in) long. “This is my biggest baby yet,” Jenny boasts proudly, as she breastfeeds him shortly after birth. She and husband Mason have three sons at home aged 18 months, 4 years, and 6 years.
Critical Thinking Exercise
Jenny’s nurse, Savannah, admitted Jenny to the mother/baby unit two hours after the delivery from the labor, delivery, and recovery suite. An hour after transfer, Jenny’s fundus is boggy, located three fingerbreadths above the umbilicus, and displaced to the right. Her perineal pads, which were changed just before transfer, are saturated. All previous assessments were normal.
Questions
a. What does this data suggest?
b. What nursing actions should be taken first?
c. Which follow-up assessments are necessary?
d. Why is it necessary to remind and assist Jenny to void?
Assessment
Jenny required catheterization. Three hours later she called Savannah to ask for help to go to the bathroom. As she stood up, Jenny became weak and dizzy and said, “Everything is going black.” Her gait was unsteady, and Savannah had to lower Jenny back to the bed to prevent her from fainting. Jenny’s color was pale, and her pulse rate was rapid.
Critical Thinking Question
a. Identify Jenny’s problem using nursing process and formulate a nursing care plan based on data provided
b. Does Savannah have enough data to identify this as a patient problem?
c. If not, what other data is necessary to obtain? Why?
