At 1410, the nurse again telephoned the provider to report Silvia's
status, including two more dark red blood clots and absent variability
with recurrent decelerations, and asked the provider to come to the
bedside for evaluation. The provider indicated she was "on the way to
the hospital" and ordered an emergency cesarean to be started by the
senior resident. Silvia was prepped for cesarean birth. The nurse is
planning to document her telephone report to the attending physician.
Given the emergent situation, the best approach to documentation would
be:
- Correct Answer - Continue providing care for Silvia and write a late
entry summarizing the conversation after the cesarean is completed
What additional action should the nurse take to minimize risk, based on
this case scenario?
- Correct Answer - Ensure that the neonatal team is notified of the
circumstances and is present for the birth
The provider delivered a male infant by cesarean birth at 1447 and noted
bloody amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10
minutes. The infant was visibly pale. Inspection of the placenta revealed
a velamentous insertion of the umbilical cord and a ruptured fetal vessel.
The umbilical cord gases were: pH 6.88/PCO2 114 mmHg/PO2 10
, mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was 20%
and the hemoglobin was 8. WHICH INTERPRETATION OF THSE
UMBILICAL CORD AND INITIAL NEONATAL BLOOD RESULTS IS
CORRECT?
- Correct Answer - The neonate is anemic
The provider delivered a male infant by cesarean birth at 1447 and noted
bloody amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10
minutes. The infant was visibly pale. Inspection of the placenta revealed
a velamentous insertion of the umbilical cord and a ruptured fetal vessel.
The umbilical cord gases were: pH 6.88/PCO2 114 mmHg/PO2 10
mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was 20%
and the hemoglobin was 8. THESE UMBILICAL CORD GASES
INDICATE:
- Correct Answer - Mixed acidosis (respiratory & metabolic)
CASE STUDY B) NELL. Nell, a 24-year-old G3 P020 at 42&3 weeks
arrived on L&D for an evening IOL for post-dates. Nell has had an
exploratory lap. to remove scar tissue on her L ovary and intestines and
has had infrequent menstrual cycles. She had has 2 SABs - at 12 and 5
weeks. Prenatal labs were WDL. Her thyroid is enlarged; however, her
TSH, T4, and T3 were done at 39 weeks and were WDL. Nell has a
family history of HTN. An US at 19 weeks revealed a low-lying placenta
that resolved by 37 5/7 weeks. Today in triage, an US revealed an EFW
of 3300g and an AFI of 3 cm. Nell has had reactive NSTs. Admission
vital signs were WDL. SVE findings: fingertip, 40%, and -2 station.
Membranes intact and cephalic presentation. Nell denied feeling regular
cramping. Category I tracing. A vaginal prostaglandin insert was placed.
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