Case Study 1.

Name: ____________________________________ Level: ________ Group: _____Date: _________

INSTRUCTIONS. All questions apply to this case study. Your responses should be brief and direct 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. Please write your answers clearly/legibly. Corresponding credit (score)will not be given for answers that are
not readable. Scan/take a picture of your answers and submit/upload the file thru VLE/MESSENGER/EMAIL.

Test 1 Case Scenario

 Scenario: You are the nurse working in labor and delivery unit at a local hospital. Ms. AB comes to the unit
having contractions and appears 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, that is,
whether to do a vaginal exam or to continue asking her more questions.
1. What three initial questions will you ask, and why?
1._______________________________________________________________
2._______________________________________________________________
3._______________________________________________________________
2. She states that her last monthly period was last June 10, 2019. Compute for the AOG and EDC.
1. AOG ______________
2. EDC ______________
3. Ms. AB has contractions 2 to 3 minutes apart lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her
bag of water is intact at this time. Upon checking her UTZ report, her due date is 2 days away. You determine that it
is appropriate to ask for further information before a vaginal exam is done. What information do you need?
______________________________________________________________________________________________
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4. Upon examination, Ms. AB is 80% effaced and 6 cm dilated. The fetal heart rate (FHR) is 152 beats/min and regular.
She is admitted to the labor and delivery room in the unit. What nursing measures should be done at this time?
______________________________________________________________________________________________
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5. List the stages of labor. Ms. AB is in what stage of labor?
______________________________________________________________________________________________
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6. Ms. AB states that she is experiencing discomfort and asks you whether there is an alternative therapy available
before taking medication. List at least two alternative methods in order to alleviate her discomfort.
______________________________________________________________________________________________
______________________________________________________________________________________________
7. As you assess both the mother and the fetus during the active stage of labor, you will watch out for abnormal
findings. Which of these are potential abnormal findings during labor?
(Select all that apply.)
a. Unusual bleeding
b. Brown or greenish amniotic fluid
c. Contractions that last 40 to 70 seconds
d. Sudden, severe pain
e. Increased maternal fatigue
_____________________________

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  Case Study Progress
Although Ms. AB continues to use alternative therapies for discomfort, she asks for pain medication and receives
a dose of Hyoscine-N-Butylbromide (Buscopan) 10 mg IM and IV. Three hours later, MS. AB. is lying on her back,
and during contractions you notice a few late decelerations of the FHR. You stayed with Ms. AB to monitor her
and her fetus and immediately call for someone to notify the attending Physician.

8. Put these actions in order of priority:

a. Discontinue the oxytocin infusion.
b. Turn Ms. AB onto her left side and elevate her legs.
c. Increase the rate of the maintenance IV fluids.
d. Administer oxygen at 8-10 L/min by facemask.
___ ___ ___ ____
9. What are the 3 patterns of deceleration?
__________________________________________________________________________________________________
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10. As you monitor Ms. AB, you observe for prolapse of the umbilical cord. Describe what this is and what can happen to
the fetus if this occurs.
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11. What would be the appropriate nursing actions if you noted that Ms. AB had a prolapsed cord?
__________________________________________________________________________________________________
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 Case Study progress

The decelerations stopped, and the remainder of the labor is uneventful; Ms. AB had an episiotomy to facilitate
the delivery of a male infant.
12. What are the essential interventions in the immediate care of the newborn?
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__________________________________________________________________________________________________

13. Ms. AB. has her episiotomy repaired and the placenta delivered. What are the signs of placental expulsion?
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14. What assessments are important for Ms. AB following delivery?
__________________________________________________________________________________________________
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15. What interventions must be done in order to achieve and maintain a well contracted uterus to prevent hemorrhage?
1. __________________________________________________________________________________
2. ___________________________________________________________________________________
3. ___________________________________________________________________________________
 Case Study Outcome:
Ms. AB and her newborn baby girl are taken to the maternity unit where she begins to breastfeed him.
15. What are the proper breastfeeding instructions that must be given to Ms. AB.
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Prepared by: Sharon M. De Vera RN, MAN
Faculty NEU-CON