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MATERNAL AND CHILD NURSING

Nursing Care of the Laboring Patient

Scenario 1:

Cindy, a 17 year-old G1P0 is admitted to the labor and delivery unit for an induction at 38 weeks gestation. She was diagnosed with preeclampsia at 34 weeks gestation. She has been on strict bed rest for the past 4 weeks. 

 

She has been doing daily fetal kick counts and had a BPP done 2 days ago which was normal. She has been placed on an external fetal monitor and FHT’s are 125-135 with accelerations noted. The external contraction monitor shows no contractions and Cindy denies feeling any contractions. A vaginal exam is done and she is 2 cm dilated, 75% effaced and the fetus is at a 0 station. 

 

An IV of LR has been started in her left forearm and is running at 75ml/hr. The physician has prescribed MgSO4 and has ordered initial admission labs: CBC, Blood type A+ and Cross and a Liver Profile now and a MgSO4 level to be drawn in 2 hours. The time is now 0800. 

 

1. What is the normal loading dose for MgSO4? What assessments should the nurse perform related to the administration of MgSO4 and potential side effects? Why is Cindy receiving this medication? 

 

2. The loading dose has been administered and was @ complete 0830. The physician has ordered the maintenance dose to be 2 GM/hour. The MgSO4 has arrived from pharmacy mixed as 40Gm in 1000cc of LR. Calculate the hourly rate in ml/hour. 

 

3. It is 0845 and you have placed a foley catheter with a urimeterattached per physician’s orders and are to perform an hourly assessment of intake and output. Upon placing the foley catheter you receive a return of 150 mls of urine. 

 

The physician has also ordered a pitocin drip to be administered to begin the induction of labor. The order is to administer the pitocin at 2 milliunits per minute and increase by 2 milliunitsevery 30 minutes until regular, moderate contractions are achieved. 

a. You mix 20 units of pitocin in 1000 milliliterss of LR. How many milliliters per hour will you set the IV pump for to achieve the rate of 2 milliunits per minute?

 

4. What side effects should the nurse monitor for related to the administration of pitocin?

 

5. The pitocin drip was started at 0900. The time is now 1100. The pitocin drip is currently set at 8 milliunits per minute. Cindy is having contractions every 3 minutes, lasting 60 seconds. The contractions are moderate on palpation. She is having a difficult time coping with the contractions and is requesting something for pain. You assess the fetal heart tones and note that the fetal heart rate (FHR) is 130-140 with accelerations and occasional mild variables. You perform a vaginal exam and note that Cindy is 3-4 cm’s dilated and 100% effaced, with the fetus at a 0 station. 

a. What nursing actions would you perform at this time? 

b. What lab result needs to be verified? 

 

6. The physician has stated that Cindy cannot have her epidural until she is 5 cms and he would prefer not to administer any narcotics for the pain. What can you as the nurse do to help Cindy cope with her contractions? 

7. You have just performed a vaginal exam and determined that Cindy is now 6 cms dilated. Anesthesia has come and placed the epidural and Cindy is beginning to feel relief from the pain of her contractions. 

a. What side effects should you as the nurse monitor for in relation to the epidural? 

b. What interventions would be performed for the potential side effects? 

 

8. Cindy is complaining of “feeling a lot of pressure down there”. FHR is 120-130 with early decelerations down to 70. What nursing action(s) would you perform? 

 

9. A vaginal exam reveals that Cindy is 10cms, 100% effaced and the fetus is at a +3 station. What actions do you as the nurse need to take? What preparations need to be made for the anticipated delivery? 

 

10. Cindy delivered a 7lb 4oz baby girl. Initial assessment of the infant reveals the following 

 

Heart rate 

Respiratory rate 

Muscle tone 

Reflex irritability 

Color 

125 

Slow, weak cry 

Some flexion 

Cry 

Body pink, extremities blue 

 

Determine the 1 minute Apgar score based on the above information. What actions should you as the nurse take? What factors may have influenced the infant having a slow weak cry and only some flexion of the extremities?

Scenario 2:

Summer, a nulliparous woman, is in the transition stage of the first stage of labor and is nearing the second stage. She and her coach (father of the baby) have been working together effectively for most of labor, but Summer lost control during transition. Summer says she is exhausted and cannot imagine how she will be able to go on and to push.

1.     What criteria should be used to determine whether Summer has progressed to the second stage of labor?

2.     Summer is confirmed to be in the second stage of labor. She is tired and does not want to push right now. Fetal station is 1+ and position is ROA. Summer is not yet experiencing an urge to bear down. What would be an effective approach for the nurse to take at this time? Support your answer.

3.     Summer begins to feel the urge to bear down about 30 minutes after the second stage of labor begins. She is very anxious, stating that she cannot remember exactly what the childbirth teacher told her to do now. Her coach is unsure how to help her. What nursing action should be taken?

4.     Summer’s baby girl is born without the need for an episiotomy. Only a 1º perineal laceration occurred. What signs indicate that the expected events of the third stage of labor are occurring?

5.     At present Summer’s flow is moderate to heavy with a few clots. What measures should be used to ensure fundal contraction?

6.     Discuss the measures the nurse should use to help Summer and her partner bond with their baby daughter.

PSYCHIATRIC/MENTAL HEALTH NURSING

Scenario 1:

Susan is hospitalized as she is suffering from generalized anxiety disorder that is interfering with her ability to function in her daily life. Her provider just informed her that the treatment team is developing a care plan that includes medication and education regarding coping skills/lifestyle modifications. Susan tends to ask a lot of questions, and as her nurse, you want to be fully prepared to help her with her new treatment plan. 

 

Identify a possible medication for anxiety disorder and what patient information (side effects and patient education) will you need to give Susan? 
What are appropriate interventions for Susan’s anxiety? Be sure you know which things are in the scope of nursing practice and which interventions are out of the scope of nursing practice. Provide at least two interventions and describe how they will help Susan.

Scenario 2:

53-year-old Peter has an intellectual disability. He has lived a very sheltered life with his elderly parents who have always cared for him. Peter & his parents have their own way of communicating. As his parents are in their 80s and are in poor health, they are very worried about what will happen to Peter when they’re unable to take care of him.

As a care worker, you’re going to assess the situation regarding Peter and his ongoing care.

Identify Peter’s skill development needs using a person-centred approach? 
Detail the communication techniques you could use to engage with Peter to identify his learning goals. 
What would be required to plan Peter’s ongoing skill development?
How will you ensure Peter’s development strategies are respectful, motivating and empowering?
Who else will you need to work with to help Peter achieve his objectives and goals?

ORAL HEALTH, NUTRITION IN NURSING

Scenario:

O.H.N.  is a 85 year old male who has been diagnosed with the following health conditions:

Diabetes (diagnosed since 68 years old)
Hypertension (diagnosed since 50 years old)
High Cholesterol (diagnosed since 65 years old)
Obesity (diagnosed since 65 years old)
Gum Disease (diagnosed since 55 years old)

The following medications have been prescribed:

o  Tanzieum – taken once weekly

o  Crestor

o  HCTZ

o  Lasix

o  Lisinopril

·        O.H.N. often has dry mouth which affects the way food tastes and his bridge fits his mouth.

·        O.H.N. is living in a low-income seniors’ apartment in the community.

·        O.H.N. has Medicare and Medicaid for his insurances.

·        O.H.N. has meals delivered through Meals on Wheels, based upon recommendations from the registered dietitian.

·        O.H.N. has three children who take him out to dinner occasionally (birthdays/holidays).

·        O.H.N.  has mints in his pocket which he takes often when his mouth is too dry and also often drinks carbonated beverages to keep his mouth moist.

1.   What concerns do you have for O.H.N. regarding oral health and nutrition? (Note: Explain what conditions may lead to adverse effects such as gum disease as well as methods to address his chronic health concerns.)

2.   What individuals/agencies should be involved in addressing these concerns? (Note: Which health care providers/organizations should be included in the discussion or be consulted regarding oral health and nutrition concerns?)

3.   How would you develop an intervention/care strategy of reducing the potential risks for O.H.N. experiencing adverse reactions for each of his chronic diseases? (Note: What steps should be taken to address his oral health and nutrition needs given his multiple chronic health conditions).

4.   What can O.H.N. do to reduce the potential for adverse effects related to his oral health and nutrition? (Note: What changes may be necessary to reduce preventable adverse events?)

5.   What other agencies can assist with improving O.H.N.’s oral health and nutrition needs to minimize adverse effects? (Note: Think about methods for treating each of the chronic diseases and how changes to oral health and nutrition can be improved. How can this care be coordinated?)

6.   What processes or procedures are necessary to safeguard O.H.N. from experiencing an adverse effects related to his oral health and nutrition? (Note: Think Interagency – Team-based approach).

SCIENCE
HEALTH SCIENCE
NURSING

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