NAME: Sumbad, Mark Bhen E.

NBA-2
III. NURSING CARE OF A HIGH-RISK PREGNANT CLIENT DURING LABOR AND DELIVERY

ACTIVITY 1
Case study on Problems with Power

Instruction: Please download or re-type this sheet, ANSWER the questions and send it to
our google classroom. For those with Slow internet or no internet, you may write it on a bond
paper, take a snapshot and PM it to my messenger account

CASE #1:
A 26 y/o G1P0 woman at term, who is in labor has adequate pelvis on clinical
pelvimetry, with nonimmune rubella status. Her cervix has changed from 4cm to
7cm dilation over 2 hours with uterine contractions noted every 7-10 minutes.
QUESTIONS:

1. DOES THE CLIENT ACHIEVE THE NORMAL ACTIVE PHASE OF LABOR? YES
OR NO. EXPLAIN YOUR ANSWER IN 3 -5 SENTENCES ONLY
- The client doesn’t achieve the Normal Active Phase of Labor. Because during the
normal active phase of labor, contractions grow stronger, lasting 40 to 60 seconds,
and occur approximately every 3 to 5 minutes. And the client is having uterine
contractions noted every 7-10 minutes, which is more than the required uterine
contractions every minute which is 3-5 minutes.

2. WHAT IS THE MANAGEMENT FOR THE ABOVE CASE?

- The management for the above case are induction and augmentation of labor
with oxytocin or amniotomy that could be initiated to strengthen them.
CASE#2:
A 26 y/o G2p1 at 40 wks AOG has been pushing for 3hours without progress. Throughout
this time, her vaginal examination has remained completely dilated, completely effaced,
and at zero station, with the head persistently in the occiput-posterior position

1. WHAT PROBLEM WITH THE PASSAGE IS DESCRIBED IN THE ABOVE

SCENARIO?
- The problem with the passage described above in the scenario is the
problem with fetal position or presentation.

2. WHAT PROBLEM WITH THE POWER IS EXPERIENCED BY THE CLIENT?

- The problem with the power experienced by the client is the prolonged
descent.

3. WHAT IS THE MANAGEMENT FOR THESE PROBLEMS?

- Bed Rest and fluid intake can be a management for these problems. If the
membranes have not ruptured, rupturing them at this point may be helpful.
And to induce the uterus to contract effectively we may use Intravenous (IV)
oxytocin. Proper positioning are also a must which Semi-fowler’s position is
the best and squatting and kneeling are also needed.
CASE #3:
A 25 y/o obese G2P1 woman is delivering at 42 weeks AOG; the fetus appears clinically
to be 3000g. After a 4-hour first stage of labor, and a second stage of labor, the head
delivers but the shoulders do not easily deliver.

1. WHAT MANEUVER IS BEST TO DELIVER THE SHOULDER?

- The best maneuver to deliver the shoulder is McRobert’s maneuver. It is
effective due to the increased mobility at the sacroiliac joint during pregnancy,
allowing rotation of the pelvis and facilitating the release of the fetal shoulder.
2. WHAT ARE THE RISK FACTORS THE CLIENT HAVE TO PREDISPOSE HER
FOR SHOULDER DYSTOCIA?
- Shoulder dystocia is most apt to occur in women with diabetes, in multiparas,
and in post-date pregnancies. This is hazardous to the woman because it can
result in vaginal or cervical tears.

3. WHAT IS THE COMMON NEONATAL COMPLICATIONS THAT CAN OCCUR

W/ SHOULDER DYSTOCIA?
- Fractured clavicle or a brachial plexus injury for the fetus is the common
neonatal complications that can occur with shoulder dystocia.