Renee Wilson, 26 y/o G1P0 admitted four hours ago to the Birthing Center.
She has had an uncomplicated pregnancy, but her obstetrician has
expressed the concern about needing a c-section because of the anticipation
of a large baby. Her last ultrasound estimated fetal weight at 9 lbs. 6 oz. She
...
Renee Wilson Room 302
Renee Wilson, 26 y/o G1P0 admitted four hours ago to the Birthing Center.
She has had an uncomplicated pregnancy, but her obstetrician has
expressed the concern about needing a c-section because of the anticipation
of a large baby. Her last ultrasound estimated fetal weight at 9 lbs. 6 oz. She
and her husband have attended Lamaze Prepared Childbirth Classes and
their Birth Plan includes the desire to have an unmedicated labor and vaginal
birth. She also desires skin to skin contact with her baby at birth and
breastfeeding. Admit assessment findings: Sterile vaginal exam (SVE) - 4 cm,
80% effaced, and fetal vertex at a -2 station with intact membranes, slight
bloody show. BP 110/70 mmHg, P. 88 beats/minute, R 24 breaths/minute; T
98.8 F. 37.1 C. FHR 150 baseline with moderate variability + accelerations,
absent decelerations (Category 1). Contractions are occurring every 2
minutes, lasting 60 seconds with moderate intensity per palpation. Portable
tocodynamometer and fetal ultrasound transducer are in place. She is using
shallow-chest breathing and conscious relaxation techniques and is
ambulating in her room. She rates her pain at 5/10. She tells you that
she will feel like a failure if she can’t deliver vaginally.
You responded correctly to 5 out of 6 evaluations:
Your
Category response Explanation
Educational Increased Status assessment reports she is a G1 having attended childbirth classes, but
Needs acuity first-time mothers require focused education and reinforcement of concepts
learned.
Fall Risk Increased Status assessment reports she is pregnant and is experiencing changes in
acuity balance and center of gravity.
Health change Patient is in labor and is experiencing a change in health status.
Increased
acuity
, Your
Category response Explanation
Pain level Increased Status assessment reports pain scale of 5/10 and using non-pharmacologic pain
acuity management techniques.
Physiological Normal Status assessment reports active labor at 5 cm dilation; potential c-section due
Needs acuity to fetal macrosomia.
Sensorium Normal Status assessment reports no indication of altered sensorium.
Needs acuity
You correctly diagnosed 11 out of 13 options:
Physiological
Your
Description Response Explanation
Acute Pain True Status assessment reports frequent contractions, use
of breathing techniques and report of pain 5/10.
Anxiety True Status assessment reports potential for caesarean-
section and woman desiring an unmedicated vaginal
birth.
Bleeding False Status assessment indicates just a slight bloody show
consistent with active labor.
Imapired mobility False Status assessment reports woman ambulating in
room, ambulation may facilitate labor and delivery.
Impaired patterns False Status assessment indicates active labor which can
of elimination impede ability to empty bladder.
Infection, Risk for True Status assessment reports a large fetus with possible
dystocia and prolonged labor.
Nausea False Status assessment does not indicate increased risk
for nausea.
Safety
Your
Description Response Explanation
Deficient Knowledge True Status report indicates attendance at childbirth
classes but each labor different requiring variety of
coping skills and education.
Fall, Risk for True Status assessment reports woman ambulating in
room and changes in pregnancy and labor may
increase for falls.
Impaired maternal True Status assessment reports potential for an
newborn bonding, undesired C-Section with perception of maternal
Risk for failure.
Risk for fetal injury True Status assessment reports fetus at -2 station
despite active labor and frequent contractions.
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