Describe how a nurse should approach this situation.
3. Write at least 3 questions a nurse would ask to elicit the appropriate information required to determine the course of action required. (Write out as if you were the nurse answering the phone)
4. Based on the data collected during the telephone interview, the nurse determines that Mercy is in very early labor. Because she lives fairly close to the hospital, she is instructed to stay home until her labor progresses. Outline the instructions and recommendations (cite references and provide rationale) for care Mercy and her husband should be given for the nursing diagnosis: Readiness for enhanced knowledge of labor progression RT lack of exposure
5. A week later, Mercy arrives to Labor and delivery at 39 weeks gestation. A nurse uses Leopold’s maneuvers to assess the position of the baby in the uterus. A soft round mass is felt in the fundal region. A flat object is noted on the left and small objects are noted on the right of the uterus. A hard round mass is noted above the symphysis. The nurse would document which position consistent with these findings?
6. The nurse notes on the labor record that the fetal heart tracing has the following: contraction frequency every 3 minutes, fundus palpates the same consistency as the forehead at the peak of contractions; fetal heart tones 140 bpm, early decelerations with each contraction and return to baseline, variability moderate. Explain what this assessment means.
7. D.H. is admitted to labor and delivery for a labor induction with pitocin. Describe the procedure for pitocin induction.
a. What are the nursing responsibilities for safe administration of pitocin?
b. What are three potential complications?
8. D.H. complains of increasing headache, proteinuria is +3, and DTR’s are +3. Vital signs include Bp 154/94 mmHg, pulse 92. What is the primary concern based upon this assessment?
9. The physician orders magnesium sulfate infusion 4 gram bolus over 30 minutes, then 2 gm per hour. The pharmacy sends up an IV bag of 1 liter Lactated Ringers with 40 mg magnesium sulfate for a secondary line. Describe the procedure for magnesium sulfate infusion.
a. What is the purpose for administering this medication?
b. At what rate will the bolus be administered in mL/hr?
c. Describe the adverse effects of magnesium sulfate administration.
d. What are the nursing responsibilities for safe administration of MgSO4?
10. D.H. is being induced for labor for the past 2 hours and her cervix is 5 cm/ 80%/ 0 station. Membranes are ruptured for one hour of light yellow, colored amniotic fluid.
11. Review the stages of labor. What stage is D.H. in at this time based on the above information?
12. The obstetrician orders internal monitoring of the fetal heart rate and placement of an intrauterine pressure catheter to monitor contractions. Below is the tracing after 30 minutes of monitoring.
a. What is the FHR?
b. Describe the variability.
c. If there are any decelerations, what type is present?
d. What is the frequency of contractions?
13. What are the most appropriate nursing interventions at this time?
14. If calling the physician was on the list of appropriate nursing interventions, Write out an SBAR to the physician at this time.
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