Case Simulatio 115

Course title: DYNCM 109 RLE / CLINICAL
BSN 2-D
CASE SIMULATION 115
NAME: Fernandez, Khenn Bryle
GROUP: 15
DATE SUBMITTED: 09/10/21
INSTRUCTION. All questions apply to this case study. Your responses should be brief and to the
point. When asked to provide several answers, list them in order of priority of significance. Do
not assume information that is not provided. Please print or write clearly. If your response is
not legible, it will be marked as?, and you will need to rewrite it.
Scenario
You are the charge nurse working in labor room and delivery at a local hospital. D.H. comes to
the unit having contractions and feeling somewhat uncomfortable. You take her to the intake
room to provide privacy, have her change into gown, and asks her three initial questions to
determine your next course of action, that is, where to do a vaginal exam or to continue asking
her more questions
1. What three initial questions will you ask?
- We should ask what the contractions feel like to determine if they are Braxton
Hicks or true contractions
- How far apart are your contractions? How often are your contractions occurring?
- Has your water broken? or Are you having a bleeding?
2. D. H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third

pregnancy ( gravida 3, para 2002). Her bag of water is intact at this time. She states that
her due date is 2 days away. You determine that it is appropriate to ask for further
information before the vaginal exam is done. What information do you need before the
vaginal exam?
- The pt just admitted to L&D
⮚ 3 initial questions before the Vaginal Exam? Why?

- What is your chief complaint or reason for coming to the hospital?
- Do you have any bleeding or pain? If yes, please describe the color, consistency,
amount, and the location and level of pain on a scale of 0-10
SUBMITTED TO: SHEILA MARIE FORTUNA

CLINICAL INSTRUCTOR
BSN 2-D
CASE SIMULATION 115
GROUP: 15
- Progress of Labor. (1) Time and onset of contractions and progress in terms of
frequency, duration, and intensity. (2) Location and character of discomfort from
contractions
The pt just admitted to L&D. What would be the 3 initial questions that you want to ask
your pt before you do a Vaginal Exam or to determine your next course of action. Why?
3. What assessment should you make to gain further information from DH?
- Contraction pattern: Palpate abdomen for strength of contractions, frequency, and

duration.
- Cervical dilation and effacement, presentation, and position.
- Amniotic membrane status.
- Fetal heart rate (FHR): It is common to use a hand-held Doppler monitor; note
rate and any slowing or acceleration.
4. Upon examination, D. H. is 80% effaced and 4cm, FHR is 150 beats/min, and regular. She
is admitted to a labor and delivery room on the. What nursing measures should be done
at this time?
- Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation.

- During this phase, contraction intensity is stronger, interval shortens, and duration
lengthens.
- This is where true discomfort is first felt by the patient so she is dependent and
her focus is on herself.
5. As part of your assessment, you review the fetal heart strip pictured below. What will
you do?
- Nothing; these are early decelerations and are usually caused by fetal head
compression.
- Continue to monitor so that they can be distinguished from late or variable
decelerations.

CLINICAL INSTRUCTOR
BSN 2-D
CASE SIMULATION 115
GROUP: 15
6. List the stages of labor. DH. is in what stage of labor?
- Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation.

During this phase, contraction intensity is stronger, interval shortens, and duration
lengthens.
- This is where true discomfort is first felt by the patient so she is dependent and
her focus is on herself.
7. D.H. states that she is feeling discomfort and asks you whether there is alternative
therapy available before taking medication. List at least four alternative methods to
assist DH. with controlling her discomfort.
- Institute non-pharmacological pain measures (e.g. breathing exercises, distraction

method, imagery, music therapy, etc.)
- Assist patient in assuming her breathing exercises.
- For those who can’t stay upright, left-side lying is recommended to avoid
disruption in fetal oxygenation
- Change positions to promote comfort; use pillows, imagery, and visualization;
conscious breathing
8. As you assess both the mother and the fetus during active labor, you will look for
abnormalities. Which of these are potential abnormalities during labor? ( select all that
apply)
a. Unusual bleeding
b. Brown or greenish amniotic fluid
c. Contraction that last 40 to 70 seconds
d. Sudden, sever pain
e. Increased maternal fatigue
CASE STUDY PROGRESS

Although D.H. Continues to use alternative therapies for discomforts, she asks for pain
medication and receives a dose of Meperidine (Demerol). Three hours later, D.H. is lying
on her back, and during contractions you notice a few late decelerations of the FHT. You
stay with D. H. to monitor her and her fetus and immediately call for someone to notify
the Primary Care Physician.

CLINICAL INSTRUCTOR
BSN 2-D
CASE SIMULATION 115
GROUP: 15
9. Put these actions in order of priority: BDAC

a. 2. D/C the oxytocin infusion
b. 1. Turn onto her left side and elevate legs
c. 4. Increase the rate of the maintenance of IV fluid
d. 3. Administer oxygen at 8-10L/min by facemask
10. Deceleration occur in an early, variable, or late pattern. What is the significance of
these patterns? State what the nurse should do for each type.
- Decelerations are temporary drops in the fetal heart rate.

- There are three basic types of decelerations:
- early decelerations,
- late decelerations, and
- variable decelerations.
- Early decelerations are generally normal and not concerning.
- Late and variable decelerations can sometimes be a sign the baby isn’t doing well.
11. As you monitor D. H., you observe for prolapse of the umbilical cord. Describe what this
is and what can happen to the fetus if this occurs.
- Umbilical cord prolapse is a complication that occurs prior to or during delivery

of the baby.
- In a prolapse, the umbilical cord drops (prolapses) through the open cervix into
the vagina ahead of the baby.
- The cord can then become trapped against the baby's body during delivery.
Umbilical cord prolapse occurs in approximately one in every 300 births.
12. What would be done if you noted prolapse?

CLINICAL INSTRUCTOR
BSN 2-D
CASE SIMULATION 115
GROUP: 15
- If the doctor finds a prolapsed cord, he or she can move the fetus away from the
cord in order to reduce the risk of oxygen loss.
- Firstly, call for help – umbilical cord prolapse is an obstetric emergency.
- It should be managed as follows:
- Avoid handling the cord to reduce vasospasm.
- Manually elevate the presenting part by lifting the presenting part off the cord by
vaginal digital examination.
- Encouragement into left lateral position with head down and pillow placed under
left hip or knee-chest position. This will relieve pressure off the cord from the
presenting part.
CASE STUDY PROGRESS

The Decelerations stop, and the remainder of the labor is uneventful; D.H. has an
episiotomy to allow more room for the infant to emerge and delivers a male infant.
13. What is involved in the immediate care of the newborn?
- Drying the baby with warm towels or cloths, while being placed on the mother's
abdomen or in her arms. This mother-child skin-to-skin contact is important to
maintain the baby's temperature, encourage bonding and expose the baby to the
mother's skin bacteria.
14. You assess the newborn, you observe for CNS depressant effects that might result
because the mother received an opioid during labor. Opioid antagonists such as
Naloxone ( Narcan) can promptly reverse the CNS depressant effects in the newborn,
but when is naloxone contraindicated for infants? When Naloxone is contraindicated
for infants?
- Opioid antagonists such as Naloxone ( Narcan) can promptly reverse the CNS
depressant effects in the newborn, but when is naloxone contraindicated for
infants?
- When Naloxone is contraindicated for infants?
- Caution in infants with tachycardia, congenital heart defects.
- Not indicated if the infant shows no sign of respiratory depression.
- Newborns of mothers who are known or suspected to be physically dependent on
opioids.
- In such cases an abrupt and complete reversal of narcotic effects may precipitate
an acute abstinence syndrome.

CLINICAL INSTRUCTOR
BSN 2-D
CASE SIMULATION 115
GROUP: 15
15. D.H. has her episiotomy repaired and the placenta delivered. What are the signs that
the placenta has released from the uterine wall?
- The following 3 classic signs indicate that the placenta has separated from the
uterus :
1. The uterus contracts and rises.
2. The umbilical cord suddenly lengthens.
3. A gush of blood occurs.
16. What assessments are important following delivery?
- All postpartum women should have regular assessment of:

1. vaginal bleeding,
2. uterine contraction,
3. fundal height,
4. temperature and heart rate (pulse) routinely during the first 24 hours starting from
the first hour after birth.
5. Blood pressure should be measured shortly after birth
CASE STUDY OUTCOME

D.H. and her newborn baby boy are taken to the maternity unit where she begins to breastfeed
him

CLINICAL INSTRUCTOR

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Course title: DYNCM 109 RLE / CLINICAL

2. D. H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third

- The pt just admitted to L&D

⮚ 3 initial questions before the Vaginal Exam? Why?

SUBMITTED TO: SHEILA MARIE FORTUNA

- Contraction pattern: Palpate abdomen for strength of contractions, frequency, and

- Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation.

SUBMITTED TO: SHEILA MARIE FORTUNA

6. List the stages of labor. DH. is in what stage of labor?

- Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation.

- Institute non-pharmacological pain measures (e.g. breathing exercises, distraction

CASE STUDY PROGRESS

SUBMITTED TO: SHEILA MARIE FORTUNA

9. Put these actions in order of priority: BDAC

- Decelerations are temporary drops in the fetal heart rate.

- Umbilical cord prolapse is a complication that occurs prior to or during delivery

12. What would be done if you noted prolapse?

SUBMITTED TO: SHEILA MARIE FORTUNA

CASE STUDY PROGRESS

SUBMITTED TO: SHEILA MARIE FORTUNA

16. What assessments are important following delivery?

- All postpartum women should have regular assessment of:

CASE STUDY OUTCOME

SUBMITTED TO: SHEILA MARIE FORTUNA

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