doogle Case study 2

doogle Case study 2

Scenario 1

Question 1. Most important questions to ask for a nurse to ask a patient to determine if she is pregnant

The first question to ask is how the patient is whether the patient has had amenorrhea or when was the last time she received her menstruation?   The second question is on how she is feeling physically, such as on the tenderness of her breast.

Question 2. How to record information on a woman who has never been pregnant

An O.B. nurse will indicate that the nulligravida gravida 0, which means no pregnancies.

Question 3. Questions asked to complete a TPAL record

Some of the questions asked to complete a TPAL registration include what the number of births of possible offspring is? Have you had an abortion before? Have you had any preterm birth?

Question 4. Chart Review.

I would address the risks of having a high heart rate and the effects of high blood pressure on the unborn baby.

Question 5. Do any vital above because of concern, and what should you do?

There is no vital from the patient that is of much concern. The vitals of a normal pregnant woman in her weeks is expected to be as follows. The temperature should range between 37-37.8 degrees Celsius, which means my patient’s temperature is okay. Heart rate should be 80-90 beats per minute; our patient having 88 is doing okay. Respiratory rate should be 14- 20 breaths per minute, and therefore our patient with 16breaths per minute is excellent. Finally, the blood pressure of our patients is slightly below the normal of 116/74 mm Hg, but it is nothing to cause any alarm. All the patient is required is to ensure that the blood pressure does not fall anymore to reduce the risk of having low blood pressure. Therefore the patient should take a lot of fish, beans, eggs, lentils, cereals, and grains rich in iron, leafy, tofu, lean red meat, dark green vegetables, and nuts and seeds.

Question 6. How to calculate Due date

I would use the Naegele’s rule, which is based on the last period of my patient. I will use the first day of her last period, which is on February 2.  Therefore I will add one year to February 2, which will be next year, February 2. Then subtract three months to give me November 2. After that, add seven days, which will provide me with November 9 of the same year. This assumes that the P.M has a 28-week cycle and that the pregnancy will last for 40 weeks. The due date of my PM is then estimated to be November 7.

Question 7.s Significance of a gynaecoid pelvis?

Gynecoid pelvis is one feature of a woman in the structure of her bone, which is the shape. The primary importance is to protect a woman’s organs that are used for reproduction and digestion and also in supporting hip joints.

Question 8. Valuable specimens to obtain when doing a pelvic examination

Some of the specimens include vaginitis, foreign bodies, vaginal discharge, eversion, cysts, and other lesions.

Question 9. How do attitudes, beliefs, and feelings affect pregnancy?

A happy woman with being pregnant is most likely going to take good care of herself and her unborn child than a woman who does not want the pregnancy. This will in turn lead to giving birth to a healthy baby and fewer complications and accessible care for both of them. A woman who believes that delivery is not a natural process is most likely going to give birth through cesarean.

Question 10. What food should the P.M avoid from her favorite list of Hot dogs, yogurt, deli meat, sushi, and cheddar cheese?  I would advise her to stop talking deli meat, hot dogs, and sushi.

11. Important information to include in a P.M every visit

The P.M should visit after every four weeks in the first 28 weeks. The tests should consist of Bp, fetal movement, urinalysis, weight, and face, hand, and feet monitoring for edema. The nurse should go over the usual things such as stress,

Readiness and diet. From then the visits should be in every two weeks. The sessions should include questions on the birth process, whether the patient has a ready bag and preparations for the baby. After that, every week, between 34-36 weeks. In the case of fundal heights, the visits should be weekly starting from week 18.

12. What are the signs of ectopic pregnancy?

Some of the signs would be nausea, brown or dark red virginal bleeding, and pain in either bilateral, unilateral, or diffuse over the abdomen.

13. Six sighs of danger in pregnancy some signs include contractions before the due date, decrease in inactivity, bleeding, the calf area behind the knee becomes hot red, unexpected swelling in feet, face and hands, and stomach injury.
14. Changes in the body caused by pregnancy-induced relaxation of joints, alteration to the center of gravity, faintness, and discomforts. These changes can lead to problems with coordination and balance. In teaching P.M. about safety during pregnancy, what will you include in your teaching?

As a nurse, I would consider teaching on the orthostatic hypotension. I would teach her that she needs to take her time when she wants to go from sitting to standing. After slowly standing, she should take her time so that her body can is used to status and then start walking. I will also advise her that she should be aware of what surrounds her always.

15.) P.M. asks, “Is a vaginal exam done at every visit?” What is your response? Explain your answer. The virginal exam is only done in the initial review, and the next test is done after 36 weeks unless she has any complications.  The 36-week virginal examination is done to look at whether there are any cervix changes.

Instructions All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided.

Scenario 2 You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit, having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action, this, whether to do a vaginal exam or to continue asking her more question.

1. What three initial questions will you ask, and why? The most critical questions to ask are; has your water broken? This is asked because once the water has breached, the contractions are more muscular, and it is a sign of actual labor.  Wheres the pain felt? If it is false contractions, the pain will bein the abdomen, but real labor the pain is in the back and at the top of the bump. What time intervals are your contractions? This is to determine if its actual labor or Braxton hicks. If they go away when she is walking, they are false labor.
2. D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her bag of waters is intact at this time. She states that her due date is two days away. You determine that it is appropriate to ask for further questions before a vaginal exam is done. What information do you need?

I would like to know if there were any complications during her previous deliveries. I would ask her to confirm her due date and also tell if she has any allergies. I would also enquire about her birth plan and on whether she is under any medication.

1. What assessment should you make to gain further information from D.H.?

I would check the position of the baby. The location should be in that the shoulders come first if not place the baby in a good position monitoring her amniotic fluid. If the baby has a breech, monitor the mother’s B.P. and temperature of the other to prepare for a C section. Then check the dilation which is read in cm ranging from 0-10.then assess the pain and the cervix effacement

1. Upon examination, D.H. is 80% effaced, and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit. What nursing measures should be done at this time?

The above readings indicated that the D.H. is in active labor. A nurse should put her in bed, and answer any question she asks. Place a contraction and fetal monitor on the D.H.’s abdomen. Then help her with breathing and relaxation methods so help her handle contractions.

1. List the stages of labor. D.H. is in what stage of labor?

In the first stage of labor there are steps that include early labor, active labor, and transition to the second stage. The second stage the baby is born. The third stage is the afterbirth and the fourth stage is recovery.  The D.H. is in active labor.

1. D.H. states that she is feeling discomfort and asks you whether there is alternative therapy available before taking medication. List at least four alternative methods to assist D.H. with controlling her discomfort.

I would advise her to take conscious breaths which will help her to relax. Massage therapy is also helpful especially on her back. I would also apply cold or heat to areas that she is feeling discomfort. Lastly, use a pillow to change her position to a comfortable one.

1. As you assess both the mother and the fetus during the active stage of labor, you will look for abnormalities. Which of these are potential abnormalities during labor? (Select all that apply.)

1. Unusual bleeding
2. Brown or greenish amniotic fluid
3. Contractions that last 40 to 70 seconds
4. Sudden, severe pain
5. Increased maternal fatigue

1. Put these actions in order of priority:

3___a. Discontinue the oxytocin infusion.

_1__b. Turn D.H. onto her left side and elevate her legs.

__4_c. Increase the rate of the maintenance IV fluids.

__2_d. Administer oxygen at 8-10 L/min by facemask.

1. Decelerations occur in an early, variable, or late pattern. What is the significance of these patterns? State what the nurse should do for each type. Early declaration appear consistently and they look similar to each other. Early decelerations are brought by compression of the baby’s head in the course of contractions. Late declaration almost appears like premature declarations but shift from left to right relating to contractions. Viable decreases are not associated with the contractions of the uterus. They are caused by the contraction of the umbilical cord and are not an indication of the fetus.  In early deceleration, the nurse should stop picot in if infusing, turn the mother on one side, give 10L of O2, and determine the heart rate of the baby.
2. What this is and what can happen to the fetus if this occurs.

Umbilical cord prolapse is defined as a complication that occurs before or during baby delivery. The cord drops through the cervix to the head of the fetus. And it might be trapped on the body of the baby during delivery. It pauses a danger to life if the baby. This is because the cord might be stresses by the fetus during birth. Thus the embryo will lack enough oxygen, and it might die

1. What would be done if you noted that D.H. had a prolapsed cord? I would call a physician for help immediately. Put on gloves and insert two fingers in the D.H.’s virginal to the cervix. Put some upward pressure on the parts that are presented so that I can compress the cord. And put the D.H. in a modified Sims or extreme Trendelenburg.
2. What is involved in the immediate care of the newborn?

The baby should be dried with a warm cloth or towel while on the mother’s hands or abdomen. The contact of the baby to mother skin to skin is vital in providing temperature to the baby. A nurse should encourage the mother to bond with the baby, and also, the mother should expose her skin bacteria to the baby.

Instructions All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided.

Scenario 3 T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para in 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.

1. What is important to note in the initial assessment, the critical thing to note is that the temperature might be high B.P. might be low due to epidural. The size of the baby is a factor, and the fundal heights might be enlarged due to multigravida. You should assess whether there is swelling of episiotomy. The UTIL should be looked into and bowel eliminated, if any. The feelings of the patient should be evaluated too. ?
2. You find a boggy fundus during your assessment. What can corrective measures be instituted?  A nurse should carefully massage the fundus until they are firm. If it fails to remain firm, it might require more oxytocin. The bladder should be assessed as it can prevent the uterus from entirely contracting.
3. The patient complains of pain and discomfort in her perineal area. How will you respond?

I would respond by checking the episiotomy and perineum site. I would then apply ice on the perineum, give medication to relieve pain and spray by anesthetic spray. So that the patient can lower adema, I would advise her to sit on cold water or have a cold shower for 24hours and then a warm bath later for circulation and healing promotion.

1. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has an individual identification bracelet that matches a bracelet worn by T.N. and reviews other security procedures. Which statement by T.N. indicates a need for more teaching?

1. “If I have a question about someone’s identity, I can ask about it.”
2. “If someone comes to take my baby for an exam, that person will usually carry my baby to the exam room.”
3. “Nurses on this unit all wear the same purple uniforms.”
4. “Each staff member who takes my baby somewhere should have a picture identification badge.”

1. An hour after admission, you recheck T.N.’s perineal pad and find that there is a minimal amount of drainage on the pillow. What will you do next?

1. Ask T.N. to change her perineal pad.
2. Recheck her perineal pad in 1 hour.
3. Check the pad underneath T.N.’s buttocks.
4. Document the findings in T.N.’s medical record.

1. That evening, the NAP assesses T.N.’s vital signs. Which vital signs would be of concern at this time? The B.P. as it might be caused by blood loss in delivery, and it may lead to hypertension. The pulse rate is also a concern.

Chart Review

1. What will you do next? I would assess the amount, odor, and color of lochia, and if there is any blood under her buttocks, I will check on uterine fundus if it is boggy, then it requires massaging to be firm. I would also assess her bleeding Assess for bleeding and VS. If the B.P. does not improve, then I should notify Md.
2. T.N.’s condition is stable, and you prepare to provide patient teaching. What is patient teaching vital after delivery? I would encourage her that she should feed her baby continuously and report if the baby has a problem with breastfeeding. She should allow her kid to nap as it promotes growth. If she has excessive bleeding or feeling infected such as a high temperature of above 100.4 degrees F, she should ask for medical attention.
3. T.N. tells you she must go back to work in 6 weeks and is not sure she can continue breastfeeding. What options are available to her? I would advise her to use pumping and use the milk for the child when working while and breastfeed her once she is back.