Labor and Delivery - N106
1. A 24 year old woman, gravida 1, para 0, has come to the birth setting because she thinks she is in labor. She tells you that she felt the baby “drop” two days ago and that she has been having contractions for the past two hours. She reports that she has not had any fluid leaking from her vagina and that she does not think her membranes have ruptured. She says, “My contractions are coming every 15 minutes and they last about 30 seconds. They don’t change when I lie down and walk about. I think I saw some bloody show, but I am not sure. Do you think I am in labor?
2. A.F. is a 20 year old woman, G2 P0, who is in active labor when she comes to the birthing unit. She says that she did not attend childbirth preparation classes during either pregnancy. She does not have insurance and says that she wants to use as little medication as possible in order to keep the cost as low as possible. She is becoming quite uncomfortable, at times moaning during her contractions. The unit does not have a Jacuzzi or tub for a water bath; however, there is a shower in each labor room.
3. J.T., G2 P1, is in active labor. Her cervix is dilated to 5 cm. She is experiencing a great deal of anxiety and pain and is unable to stay in control and breathe through her contractions. She does not want an epidural, so the primary care provider has prescribed Meperidine (Demerol) and promethazine (Phenergan). J.T. says, “Hurry, please. Make the pain go away.”
4. A 30 year old woman is in labor. She is gravida 3, para 1. Her cervix is dilated to 6 cm and is almost completely effaced. Her membranes are intact. She is complaining of “too much” pain with her uterine contractions and is asking for medication. She agrees to have an epidural block.
5. A woman has been in labor for six hours. Her cervix is dilated to 4 cm and she is having mild contractions, occurring every 10-15 minutes lasting for 50-60 seconds. The external monitor shows a FHR of 130 bpm, with moderate variability. When her membranes rupture, the fluid is heavily stained with meconium, so an internal fetal scalp electrode is applied.
6. A woman is in active labor. Her cervix is dilated to 4 cm and her membranes are intact. The FHR and uterine contractions are being monitored by an external electronic fetal monitor. The nurse notes a fetal heart rate of 110 beats per minute with adequate variability. There are no decelerations, but there are occasional accelerations up to a rate of 135/minute that last for 30 seconds.
7. A client has just been admitted to the birthing unit. The nurse has taken her vital signs and completed a brief general systems assessment. The nurse now intends to perform Leopold’s maneuvers to help determine fetal position, lie, attitude, presentation, descent, and presenting part.
8. During labor, a woman’s membranes rupture. She tells the nurse, “My water just broke,
and it felt like something fell out.”
9. D.D. is in second stage labor. She is gravida 1 para 0. The fetus is quite large and the fetal
monitor is showing early signs of fetal distress. As D.D. has already been in second stage
labor for quiet a while, it seems likely that she will need an episiotomy even though she has
said that she would prefer not to have one. What would the nurse tell her about an
episiotomy?
10. M.J. is in second stage labor. She is gravida 1 para 0. Her cervix is fully dilated; the fetus is
engaged and in vertex position. The fetus is showing early, mild signs of fetal distress. The
primary care provider has indicated that either a forceps-assisted or a vacuum-assisted
birth will be necessary.
11. E.S. is in the 42nd week of gestation. Her fundal height is 38 cm. At 41 weeks, her fundal
height was 39 cm and at 40 weeks it was 40cm. Her primary care provider considers the pregnancy to be post term and plans to induce labor. E.S. says, “I guess the baby will be even bigger than we expected. However, that’s OK, since he’s a boy. He can be a football player.” The nurse replies, “Some post term babies are larger than normal, but some are smaller. It is possible that your baby may not be especially large.”
12. A 42 year old woman in the 34th week of pregnancy is admitted to the birthing unit because
she is experiencing preterm labor. She is gravida 4, para 0; previous pregnancies have
ended in miscarriage or preterm birth. Her cervix is dilated to 4 cm; uterine contractions are
occurring every 5-10 minutes. She says, “I can feel the contractions, but they aren’t
painful.” Electronic fetal monitoring, intravenous (IV) magnesium sulfate, and bed rest are
ordered. Betamethasone (a glucocorticoid) is ordered and is to be given intramuscularly
(IM) immediately and repeated in 12 hours.
13. R.C., a primigravida, has been in prolonged, active labor. She is becoming exhausted. The
primary care provider diagnosis cephalopelvic disproportion (CPD), and preparations are
being made for a cesarean birth. R.C. and her partner are very worried about the need for
surgery and are asking many questions. She says, “I’ve never been in a hospital before,
much less had surgery.” R.C. already has an IV, which was inserted early in her labor. The
nurse inserts an indwelling urinary catheter.
14. A 30 year old client, G1 P0, is in labor. She is dilated 4-5 cm and 75% effaced. Her membranes are currently intact. She has received routine prenatal care and her pregnancy has been uncomplicated.
Primary care provider’s orders include:
NPO with ice chips
IV D5NS at 100cc/hour
Demerol 50 mg IM for pain
Continuous external fetal monitoring
Assessment findings reveal:
Serious, tired, diaphoretic and restless
She is complaining of pain and is asking for medication