Chapter 19
Unfolding Case Study
1.
Option 1: a; Option 2: c
Rationale: The labor has progressed only 0.5 cm in 4 hours, indicating the active phase of labor is slower than expected.
Failure of fetal descent is a problem in the second stage of labor.
Increased risk of postpartum hemorrhage is a problem after the complete labor and birth process.
Because the contractions are being monitored externally, the strength can only be estimated by palpation.
The fetal heart rate pattern is expected and not the priority.
Rationale: The labor has progressed only 0.5 cm in 4 hours, indicating the active phase of labor is slower than expected.
Failure of fetal descent is a problem in the second stage of labor.
Increased risk of postpartum hemorrhage is a problem after the complete labor and birth process.
Because the contractions are being monitored externally, the strength can only be estimated by palpation.
The fetal heart rate pattern is expected and not the priority.
2.
Rationale: Fluid increase is anticipated due to increase in maternal temp.
Regular diet is contraindicated due to decrease in peristalsis during active labor.
There is no indication for discontinuing the Pitocin infusion because the contraction pattern and fetal heart rate (FHR) are normal.
No indication for starting magnesium sulfate or oxygen because the maternal vital signs (VS) and FHR are normal.
Nurse application of a fetal scalp electrode (FSE) is contraindicated because membranes are intact.
Preparing the patient for an amniotomy and insertion of an intrauterine pressure catheter (IUPC) is anticipated to monitor the contraction pattern more accurately.
| HCP Order | Anticipated | Not Indicated | Contraindicated |
|---|---|---|---|
| Increase IVF of LR to 125 mL/hr | ■ | □ | □ |
| Regular diet | □ | □ | ■ |
| Discontinue Pitocin infusion | □ | ■ | □ |
| Start magnesium sulfate 40 g/liter at 2 g/hr | □ | ■ | □ |
| Oxygen at 6 L/min via face mask | □ | ■ | □ |
| Insert fetal scalp electrode now | □ | □ | ■ |
| Prepare patient for amniotomy | ■ | □ | □ |
| Prepare patient for insertion of intrauterine pressure catheter |
■ | □ | □ |
Regular diet is contraindicated due to decrease in peristalsis during active labor.
There is no indication for discontinuing the Pitocin infusion because the contraction pattern and fetal heart rate (FHR) are normal.
No indication for starting magnesium sulfate or oxygen because the maternal vital signs (VS) and FHR are normal.
Nurse application of a fetal scalp electrode (FSE) is contraindicated because membranes are intact.
Preparing the patient for an amniotomy and insertion of an intrauterine pressure catheter (IUPC) is anticipated to monitor the contraction pattern more accurately.