NURS336- In class Activity: Labor Dystocia-
Please answer the questions briefly – just 2-3 sentences each! No paragraphs needed! This is to get you to think through the process of patient care as labor progresses and emergent problems present themselves. Please provide appropriate citations at the end. Please submit to the BB assignment box by the deadline. You may type into this document- Please remember to put your name on the document itself. Thank you!
Triage unit:
A 27 year old G2 P0 is admitted to L&D triage from the ER. She is 41 weeks, 3 days and has been sent over from the OB-Gyn’s office with a diagnosis of:
“Post-dates, rule-out Labor, possible induction/augmentation.”
She is experiencing mild, intermittent contractions and is able to walk and talk through them. On exam, her cervix is 40% effaced, 1-2 cms dilated and station -1. Her membranes are intact, she has a negative medical history, and plans to deliver without medication. She is 5’-1” tall and has a pregnancy weight of 168 lbs. She entered prenatal care at 34 weeks and is of unknown GBS status as she has not always kept her weekly prenatal appointments.
1. Based on the information you have currently, what risk factors can you identify for potential problems with Labor and delivery?
2. As you admit this patient to L&D triage, what would be the top four nursing actions would you initiate?
L&D unit:
After an hour, the patient is admitted to the L&D unit. She is contracting every 3-4 mins, they are of moderate strength and last 50-60 seconds. Her membranes rupture spontaneously with clear fluid and the fetal heart rate is stable at 120s-140s range with occasional accelerations. The patient is getting more uncomfortable. On vaginal exam, the nurse finds the cervix to be 80% effaced, 2-3 cms dilated and station -1 with some palpable head molding. The patient is becoming uncomfortable and requests epidural anesthesia.
3. How would you prepare the patient for epidural administration? What nursing actions would you take?
L&D unit:
After 2 hours, the patient has been comfortable resting and the OB-GYN calls for a status update. The nurse performs a sterile vaginal exam and assesses labor progress:
80% effaced/ 2-3 cms dilated, -1 station, molded vertex presenting part, contractions mild, every 5-6 minutes and lasting 40-50 seconds. Fetal heart rate is in the 140-160s range, no periodic changes noted.
4. What type of labor pattern is this?
5. What medical orders would you anticipate and why?
Approximately an hour later, After the Ob-GYN’s orders have been implemented, the primary RN goes off the unit to have lunch. The covering RN enters the room to assess the patient. This nurse immediately notices two things:
Two late decelerations have occurred with the last two contractions
The patient’s skin is extremely warm to the touch.
6. How should the RN respond to these findings, given the OB’s infusion orders?
7. What nursing interventions might address each of these problems?
8. Should the nurse call the OB-GYN at this time?

Book being used: Ricci, Kyle & Carman: Maternity and Pediatric Nursing, Second Edition