(Answers to Case studies and one nursing care plan )

Chapter 21: Nursing Management of Labor and Birth at Risk

1.  Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC.  (Learning Objective 9)

A.    In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery.

B.    Laura can’t understand why more women don’t want to try a VBAC delivery.  Discuss the possible reasons for this.

C.    Describe the management of care for a woman attempting a VBAC delivery.

2.  Carol, age 17, is pregnant with her first child.  Her menstrual dates are accurate and her date of conception is limited to one possible day.  Her physician gives her an EDC of March 28th.  Carol has gone past her due date and refuses to have her labor induced.  Carol states, “My grandmother says that the baby will come when it is good and ready.”  It is now April 14th and Carol is at 42 3/7 weeks’ gestation. She calls the office and reports that she is having a significant lower backache and she just passed “a glob of bloody mucus” from her vagina.  (Learning Objective 5)

A.  Discuss the risks a prolonged pregnancy places on Carol.

B.  What risks are there for Carol’s unborn baby?

C.  Describe the nursing care required for women in labor with a prolonged pregnancy.

Chapter 22: Nursing Management of the Postpartum Woman at Risk

1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6)

1. What are the “four T’s” that need to be assessed in a possible case of postpartum hemorrhage?
2. Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?

2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)

1. Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
2. What additional questions do you want to ask her to try to ascertain the cause of her fever?

       3. Describe the care required to treat each of these infections.

Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

1. On the evening shift in the special care nursery, you are paged to delivery room 5. When you arrive, the labor nurse says the baby has been stuck in the birth canal for a while, and the fetal heart tones are down. They use the vacuum suction to assist delivery. The doctor gets the baby out and places the infant on the radiant warmer. You are the resuscitating nurse for the infant, and you observe the following: the infant is limp, pale, gasping, has poor tone, and the heart rate is 101. (Learning Objective 1)

1. What are your first actions to aid in this infant’s recovery?
2. What Apgar score would you assign at 1 minute with these results? Explain the score for each category.

2. Tammi is an 18-year-old single mother who delivered a full-term infant 3 days ago. The father is not involved, and Tammi’s aunt is her support person. The infant is very fussy in the nursery, with mild tremors noted. Tammi is having a hard time feeding her baby, the baby spits up a lot and he does not console easily. The physician has been called to assess the infant. (Learning Objective 7)

1. What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
2. What is the acronym of the tool used in assessing the infant’s condition, and what are the top three substances used that can cause this condition?
3. Name what measures are used to test for this condition and on whom you perform the test.

3. Mandy just gave birth vaginally to her first child. Mandy and James had attended prenatal classes and had a natural childbirth. They were totally unprepared to see that baby “Rose” has a severe left-sided unilateral cleft lip and cleft palate. James is having a hard time with this and just keeps staring at the baby. Mandy begins to cry and states “I thought I was going to breast-feed my baby and now it’s impossible.” (Learning Objectives 12, 14, and 15)

1. A. Discuss the implications for bottle feeding and breast-feeding a baby with a unilateral cleft lip. Is it possible for Mandy to breast-feed Rose?
2. B. What is involved in the surgical correction of the defect? When can she eventually have a “normal” mouth and facial features?
3. C. What other problems may develop for Rose since she has this type of defect?

D. How can you assist the family bond with Rose?

NURSING CARE PLANS (NCP)  

1 from high risk OB (ch 21-24).

NCP are to be written in using the included Rubric. Do NOT use a grid format… use an “essay” style format or bullet point using the included Grading Rubric.