A 27-year-old female with a history of gestational diabetes is experiencing uterine inertia and fetal tachycardia during labor. Her temperature is 38°C, and her white blood cell count is 16,000/mm³. Which nursing intervention is most appropriate to prioritize at this time?

D) Administer intravenous fluids to correct dehydration and manage ketonuria

A) Administer a penicillin-based antibiotic to address the suspected infection

B) Initiate oxytocin infusion to enhance uterine contractions

C) Implement cooling measures to address hyperthermia

D) Administer intravenous fluids to correct dehydration and manage ketonuria

A patient in labor is receiving an oxytocin infusion and presents with elevated blood pressure, tachycardia, and a headache. The fetal heart rate is persistently tachycardic. Which nursing intervention is the most appropriate to prioritize the safety of both the mother and the fetus?

B) Stop the oxytocin infusion and administer IV fluids while preparing magnesium sulfate.

A) Continue the oxytocin infusion and monitor vital signs closely.

B) Stop the oxytocin infusion and administer IV fluids while preparing magnesium sulfate.

C) Increase the rate of oxytocin to expedite delivery due to fetal tachycardia.

D) Administer an antihypertensive medication to manage the elevated blood pressure.

A laboring patient on oxytocin infusion is experiencing fetal tachycardia with a heart rate fluctuating between 165 and 175 bpm, elevated blood pressure, and reports a worsening headache. What is the most appropriate initial nursing intervention to address the potential complications in this scenario?

C) Initiate oxygen therapy to improve fetal oxygenation

A) Increase the rate of oxytocin to enhance uterine contractions

B) Administer magnesium sulfate to manage suspected preeclampsia

C) Initiate oxygen therapy to improve fetal oxygenation

D) Continue monitoring without changes and reassess in one hour

A patient in active labor is experiencing persistent fetal tachycardia and occasional late decelerations. The healthcare team has repositioned the patient to her left side and administered supplemental oxygen. Despite these interventions, fetal heart rate irregularities continue. What is the priority nursing action to improve fetal oxygenation and reduce fetal distress in this scenario?

A) Increase the rate of intravenous fluids to improve maternal circulation.

B) Prepare for an immediate cesarean section to prevent further fetal compromise.

C) Administer magnesium sulfate to the patient to prevent eclampsia.

D) Notify the healthcare provider and prepare for potential amniotomy to expedite labor.

A labor and delivery nurse is caring for a patient experiencing persistent fetal tachycardia and occasional late decelerations during labor. The patient also has elevated blood pressure and a headache. Which nursing intervention is the priority to address the potential cause of fetal distress?

C) Reposition the patient to the left lateral position to enhance uteroplacental perfusion.

A) Administer magnesium sulfate to prevent seizures.

B) Increase the rate of intravenous fluids to improve maternal hydration.

C) Reposition the patient to the left lateral position to enhance uteroplacental perfusion.

D) Apply a fetal scalp electrode to obtain a more accurate fetal heart rate.

A patient in labor with preeclampsia is experiencing visual disturbances, nausea, and elevated blood pressure despite treatment. The fetal heart rate shows persistent late decelerations. What is the priority nursing action?

B) Prepare the patient for an urgent cesarean section

A) Increase the rate of magnesium sulfate infusion

B) Prepare the patient for an urgent cesarean section

C) Administer a bolus of intravenous fluids

D) Reassess the patient's pain management plan

A patient in labor with a history of preeclampsia presents with new-onset visual disturbances, nausea, and elevated blood pressure despite magnesium sulfate administration. Continuous fetal monitoring reveals persistent late decelerations. What is the most appropriate nursing intervention at this time?

B) Prepare for an urgent cesarean section due to fetal distress and worsening maternal condition

A) Increase the dose of magnesium sulfate to further reduce blood pressure

B) Prepare for an urgent cesarean section due to fetal distress and worsening maternal condition

C) Administer additional analgesics to manage the patient's discomfort

D) Encourage the patient to ambulate to promote labor progression

A pregnant patient with severe preeclampsia and suspected HELLP syndrome is showing signs of fetal distress and inadequate response to magnesium sulfate therapy. What is the most appropriate nursing action to prioritize in this scenario?

B) Prepare the patient for an emergency cesarean section to address both maternal and fetal complications.

A) Increase the dosage of magnesium sulfate to manage neurological symptoms.

B) Prepare the patient for an emergency cesarean section to address both maternal and fetal complications.

C) Administer antihypertensive medication to stabilize blood pressure further.

D) Initiate continuous fetal monitoring and wait for further orders from the healthcare provider.

A 32-year-old patient at 34 weeks of gestation is being closely monitored for severe preeclampsia with possible HELLP syndrome. Despite magnesium sulfate therapy, she presents with persistent visual disturbances and headaches, and her blood pressure remains elevated at 152/98 mmHg. Fetal monitoring shows persistent late decelerations and minimal variability. Which of the following nursing actions is the highest priority at this time?

B) Prepare the patient for an emergency cesarean section to address fetal distress

A) Increase the rate of magnesium sulfate infusion to control neurological symptoms

B) Prepare the patient for an emergency cesarean section to address fetal distress

C) Administer antihypertensive medication to maintain stable maternal blood pressure

D) Conduct a thorough neurological assessment to monitor for signs of eclampsia

1st stage of labour - uterine contractions progress - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased oxytocin secretion from the posterior pituitary gland stimulates uterine muscle contractions. This hormone binds to receptors on the uterine wall, enhancing calcium influx into muscle cells, leading to stronger and coordinated contractions.

• Secondary mechanism: Prostaglandin release from the decidua and fetal membranes augments uterine contractions. Prostaglandins enhance the sensitivity of uterine muscles to oxytocin and further promote cervical effacement and dilation.

• Key complication: Inadequate contraction strength or frequency, known as uterine inertia, can lead to prolonged labor and increased risk of maternal and fetal distress, necessitating medical intervention to augment labor progression.

Patient Profile

Demographics:

27, female, primary school teacher

History:

• Key past medical history: Gestational diabetes

• Current medications: Prenatal vitamins, insulin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing frequency and intensity of contractions

• Key symptoms: Lower abdominal pain, backache, mild headache

• Vital signs: Temperature 37.8°C, Pulse 110 bpm, Blood Pressure 140/90 mmHg, Respiratory Rate 20 breaths per minute

Section 1

As the labor progresses, the patient, a 27-year-old female with a history of gestational diabetes, exhibits signs of increasing contraction intensity but with concerning developments. Despite the contractions becoming more frequent, they remain irregular and inadequate in strength, suggesting uterine inertia. Upon initial assessment, the fetal heart rate is noted to be 170 bpm, indicating fetal tachycardia, which raises concerns about fetal distress. Additionally, the patient's blood pressure remains elevated at 145/95 mmHg, and her pulse is slightly increased at 115 bpm. Her temperature has risen to 38°C, which may suggest the onset of an infection or stress response to prolonged labor.

Given these findings, the healthcare team decides to conduct further diagnostic tests, including a complete blood count and a urinalysis to rule out infection as a contributing factor to her elevated temperature and headache. The laboratory results reveal a white blood cell count of 16,000/mm³, suggestive of a possible infection, and ketones present in the urine, indicating inadequate glucose control. This supports the need for careful monitoring and potential antibiotic therapy to address the suspected infection, especially considering her allergy to penicillin, which limits antibiotic options.

To address the uterine inertia, the decision is made to initiate a low-dose oxytocin infusion to augment labor and improve contraction efficacy. The healthcare team closely monitors the patient's response to the intervention, focusing on the contraction pattern, fetal heart rate, and maternal vital signs. The clinical reasoning involves balancing the augmentation of labor to prevent further complications while ensuring maternal and fetal safety. As the patient progresses into the next stage of labor, continuous evaluation will be critical to assess the effectiveness of the interventions and adapt the care plan as necessary.

Section 2

As the oxytocin infusion is initiated, the healthcare team closely monitors the patient's response. Within the first hour, the contraction pattern begins to show signs of improvement, with contractions becoming more regular and increasing in strength. However, the fetal heart rate continues to be a concern, as it fluctuates between 165 and 175 bpm, suggesting persistent fetal tachycardia. The team is vigilant in assessing the potential causes, considering both the maternal infection and the possibility of fetal hypoxia.

Despite the improvement in contractions, the patient's condition presents new challenges. Her blood pressure remains elevated at 148/98 mmHg, and her pulse has increased slightly to 120 bpm. Additionally, she reports a worsening headache and increasing fatigue, indicating that the stress of labor and potential preeclampsia may be contributing factors. The decision is made to administer intravenous fluids to address dehydration and ketones in the urine, while also initiating a non-penicillin antibiotic to combat the suspected infection. The team reassesses the need for further interventions, such as magnesium sulfate, to manage her blood pressure and reduce the risk of seizures if preeclampsia is confirmed.

As the labor progresses, the team remains attentive to the balance between managing the mother's health and ensuring fetal well-being. The patient's temperature decreases slightly to 37.8°C following the initiation of antibiotics, providing some reassurance that the infection is being addressed. Continuous monitoring and timely adjustments to the care plan are essential as the team navigates the complexities of her condition, with a focus on advancing labor safely while mitigating the risk of further complications. The next critical step involves evaluating the effectiveness of the current interventions and determining the best course of action to support both maternal and fetal outcomes.

Section 3

As the healthcare team continues to monitor the patient, new diagnostic results present additional insights into her condition. A complete blood count (CBC) reveals leukocytosis, with a white blood cell count of 15,000/mm³, supporting the suspicion of an underlying infection. C-reactive protein (CRP) levels are elevated at 45 mg/L, further indicating inflammation. The urine analysis confirms the presence of ketones, consistent with the patient's dehydration and stress response due to labor. The team is encouraged by a slight reduction in the patient's blood pressure to 140/92 mmHg following the administration of intravenous fluids, but the persistent fetal tachycardia remains a significant concern, prompting a thorough investigation of potential hypoxic stress.

In light of these findings, the clinical team intensifies their focus on optimizing fetal oxygenation. The patient is repositioned to her left side to enhance uteroplacental blood flow, and supplemental oxygen is administered at 10 L/min via a non-rebreather mask. Despite these measures, the fetal heart rate continues to fluctuate, and occasional late decelerations are noted on the fetal heart monitor. This pattern suggests intermittent fetal distress, possibly due to compromised placental perfusion. The team deliberates on the possibility of an emergent cesarean section if the fetal status does not stabilize, while also considering the administration of magnesium sulfate to manage the possibility of imminent eclampsia, given the patient's persistent headache and elevated blood pressure.

The patient experiences increasing uterine contractions, now occurring every two to three minutes, and cervical dilation has progressed to 6 cm. While the labor advances, the team remains vigilant in monitoring the patient and fetus, adjusting interventions as needed to maintain equilibrium between maternal stability and fetal safety. The ongoing assessment of both maternal and fetal parameters, along with the timely interpretation of diagnostic data, guide the team in making informed decisions about the next steps in the patient's care, ensuring preparedness for any further complications that may arise. The focus remains on achieving a safe delivery while mitigating risks associated with both the infection and potential preeclampsia.

Section 4

As labor continues, the healthcare team closely observes changes in the patient's status. Approximately an hour after the administration of supplemental oxygen and repositioning, the patient's contractions intensify, and she reports increasing discomfort despite analgesic support. Her cervix has now dilated to 8 cm, signaling rapid progression through the first stage of labor. However, the team notes a concerning shift in her clinical presentation: the patient develops new-onset visual disturbances and nausea, symptoms that may indicate a worsening preeclamptic state. Her blood pressure has risen again to 156/98 mmHg, prompting the team to reevaluate their management strategy.

In response to these developments, the team decides to administer a loading dose of magnesium sulfate to prevent seizures associated with severe preeclampsia. Simultaneously, they initiate continuous fetal monitoring to keep a close watch on the fetal heart rate, which remains erratic with persistent late decelerations. A repeat blood pressure check shows a slight reduction to 150/96 mmHg after the magnesium sulfate infusion, but the patient's symptoms persist, heightening the team's concern about the risk of eclampsia. With the fetus still exhibiting signs of distress and the maternal condition showing signs of instability, the team prepares for the possible need for an expedited delivery.

Anticipating potential complications, the team discusses the possibility of proceeding with an urgent cesarean section if the fetal heart rate patterns do not improve. Meanwhile, they continue to provide supportive care, including hydration and monitoring of electrolytes, given the patient's ketonuria and preeclampsia. The focus remains on balancing the urgency of delivery with maternal and fetal safety, ensuring that all interventions are in place to swiftly address any further complications that may arise during this critical phase of labor.

Section 5

As the team continues to monitor the patient closely, new diagnostic results reveal further insights into her condition. The laboratory tests return, indicating worsening proteinuria with a protein/creatinine ratio of 0.45, suggesting significant renal involvement consistent with severe preeclampsia. Additionally, the patient's liver function tests show elevated levels of AST and ALT, hinting at possible HELLP syndrome, which requires immediate attention due to its potential for rapid deterioration and increased risk to both maternal and fetal health.

The fetal monitoring strips show persistent late decelerations alongside minimal variability, confirming ongoing fetal distress. Despite the magnesium sulfate infusion, the patient's neurological symptoms, including visual disturbances and headaches, have not abated, raising the specter of impending eclampsia. Her blood pressure remains elevated at 152/98 mmHg, despite initial slight improvements, and her reflexes are brisk, a concerning sign that necessitates vigilant observation for any progression to seizures.

With these developments, the healthcare team convenes to reassess their approach, weighing the risks of continued labor against the potential benefits of an expedited cesarean delivery. They engage in detailed clinical reasoning, considering the balance between maternal stabilization and fetal well-being. As discussions progress, the team decides to prepare for an emergency cesarean section, briefing the patient and her family about the situation and the urgency required to optimize outcomes for both mother and child. The operating room is readied, and all necessary measures are put in place to ensure a swift transition should the decision to deliver surgically be made.