During a delivery complicated by shoulder dystocia, the nurse observes that the mother is hyperventilating and exhibiting signs of anxiety, including tingling sensations in her hands. What is the nurse's best initial action to support the mother and stabilize her vital signs?

C) Coach the mother in slow, deep breathing techniques.

A) Administer oxygen via face mask.

B) Encourage the mother to breathe into a paper bag.

C) Coach the mother in slow, deep breathing techniques.

D) Increase the intravenous fluid rate.

During a delivery complicated by shoulder dystocia, which nursing intervention is most appropriate to help reduce maternal anxiety and prevent hyperventilation while ensuring fetal well-being?

C) Guide the mother in slow, deep breathing techniques to manage anxiety and respiratory rate.

A) Encourage the mother to hold her breath and push with each contraction.

B) Provide the mother with oxygen via a face mask to improve fetal oxygenation.

C) Guide the mother in slow, deep breathing techniques to manage anxiety and respiratory rate.

D) Increase the intravenous fluid rate to maintain maternal blood pressure and placental perfusion.

A nurse is caring for a patient experiencing shoulder dystocia during delivery. The fetal heart rate has decreased to 80 bpm, and the mother's respiratory rate is 32 breaths per minute with signs of anxiety. What is the nurse's priority intervention to address both maternal and fetal status?

A) Administer supplemental oxygen to the mother

B) Encourage the mother to push with each contraction

C) Prepare for an immediate cesarean section

D) Guide the mother through focused breathing exercises

A patient experiencing shoulder dystocia during labor shows signs of maternal hyperventilation, with a respiratory rate of 32 breaths per minute and tingling in her hands. Which intervention should the nurse prioritize to optimize both maternal and fetal outcomes?

B) Administer supplemental oxygen via nasal cannula at 2-3 L/min to improve oxygenation.

A) Encourage the patient to breathe into a paper bag to reduce respiratory alkalosis.

B) Administer supplemental oxygen via nasal cannula at 2-3 L/min to improve oxygenation.

C) Increase the frequency of fetal heart rate monitoring to every minute.

D) Prepare for immediate cesarean section due to persistent fetal distress.

A nurse is part of a team managing a patient with shoulder dystocia and suspected preeclampsia during labor. The patient's blood pressure is 165/100 mmHg, and the fetal heart rate is 70 bpm. Which is the priority intervention the nurse should anticipate in this scenario?

B) Prepare the patient for an immediate cesarean section.

A) Administer intravenous magnesium sulfate to prevent seizures.

B) Prepare the patient for an immediate cesarean section.

C) Increase the rate of IV fluid administration to improve fetal circulation.

D) Apply oxygen via face mask to improve maternal and fetal oxygenation.

During the management of a patient with shoulder dystocia and suspected preeclampsia, which nursing intervention is most critical to prioritize before the emergency cesarean section?

B) Providing continuous fetal heart rate monitoring

A) Administering magnesium sulfate to prevent seizures

B) Providing continuous fetal heart rate monitoring

C) Initiating a rapid intravenous fluid bolus

D) Encouraging deep breathing exercises to reduce maternal anxiety

A postpartum patient with preeclampsia and a platelet count of 95,000/mm³ is being monitored in the recovery room after a cesarean section. Which nursing intervention is most appropriate to prevent complications associated with her condition?

B) Monitor neurological status closely and prepare to administer magnesium sulfate as ordered.

A) Encourage early ambulation to prevent deep vein thrombosis.

B) Monitor neurological status closely and prepare to administer magnesium sulfate as ordered.

C) Increase oral fluid intake to promote diuresis and lower blood pressure.

D) Apply warm compresses to the abdomen to reduce discomfort and improve circulation.

A postpartum patient who underwent a cesarean section is being monitored in the recovery room. She has a blood pressure of 145/90 mmHg, a respiratory rate of 24 breaths per minute, and a platelet count of 95,000/mm³. Considering her diagnosis of preeclampsia, which is the most appropriate initial nursing action?

B) Prepare for the administration of magnesium sulfate

A) Administer antihypertensive medication as prescribed

B) Prepare for the administration of magnesium sulfate

C) Increase the frequency of vital sign monitoring

D) Consult with hematology regarding thrombocytopenia

A postpartum patient receiving magnesium sulfate for severe preeclampsia begins to exhibit signs of respiratory distress, including shallow breathing and an oxygen saturation level of 88%. Her heart rate is 110 beats per minute. Which of the following interventions should the nurse prioritize to address the patient's condition?

D) Elevate the head of the bed and administer oxygen as prescribed.

A) Administer additional magnesium sulfate to prevent seizures.

B) Discontinue magnesium sulfate and notify the healthcare provider immediately.

C) Increase the patient's fluid intake to improve circulation.

D) Elevate the head of the bed and administer oxygen as prescribed.

A postpartum mother is exhibiting respiratory distress with shallow breathing, an oxygen saturation of 88%, and an increased heart rate after receiving magnesium sulfate for preeclampsia. The interdisciplinary team suspects fluid overload. What is the most appropriate initial nursing intervention?

B) Elevate the head of the bed and provide supplemental oxygen.

A) Administer additional magnesium sulfate to manage preeclampsia symptoms.

B) Elevate the head of the bed and provide supplemental oxygen.

C) Restrict fluid intake immediately to address fluid overload.

D) Prepare the patient for immediate intubation and mechanical ventilation.

Birth shoulder distocia - Nursing Case Study

Pathophysiology

• Primary mechanism: Shoulder dystocia occurs when the fetal anterior shoulder becomes lodged behind the maternal pubic symphysis after the delivery of the head, often due to disproportionate fetal size relative to the maternal pelvis, known as cephalopelvic disproportion.

• Secondary mechanism: Excessive fetal size (macrosomia) or abnormal fetal positioning (e.g., transverse shoulder presentation) can exacerbate the risk of shoulder impaction, as these conditions increase the likelihood of the shoulder failing to navigate through the pelvic inlet.

• Key complication: If not resolved promptly, shoulder dystocia can lead to brachial plexus injury due to excessive traction on the fetal head and neck during delivery, resulting in potential neonatal morbidity, including Erb's palsy.

Patient Profile

Demographics:

32-year-old female, teacher

History:

• Key past medical history: Gestational diabetes, previous C-section

• Current medications: Prenatal vitamins, insulin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Difficulty delivering baby due to shoulder dystocia

• Key symptoms: Prolonged labor, maternal fatigue, decreased fetal movement

• Vital signs: Blood pressure 145/90 mmHg, heart rate 110 bpm, respiratory rate 24 breaths per minute, temperature 98.6°F, oxygen saturation 94%

Section 1

As the delivery team worked to address the shoulder dystocia, the obstetrician implemented the McRoberts maneuver, instructing the nursing staff to assist in hyperflexing the maternal hips to increase the pelvic outlet. Despite these efforts, the fetal heart rate began to show signs of distress, with a deceleration pattern to 90 bpm, suggesting potential hypoxia. The mother, already exhibiting signs of maternal fatigue and anxiety, was encouraged to remain as calm as possible while the team strategized further interventions.

The decision was made to perform a suprapubic pressure maneuver in an attempt to dislodge the fetal shoulder. During this intervention, the nurse closely monitored the mother's vital signs, noting an increase in blood pressure to 150/95 mmHg and respiratory rate climbing to 28 breaths per minute, indicating heightened maternal stress. The fetal heart rate briefly improved to 110 bpm, yet variability remained minimal. The mother also reported tingling sensations in her hands, potentially due to hyperventilation or anxiety, necessitating supportive coaching to regulate her breathing.

As the obstetrician prepared for a potential episiotomy to facilitate delivery, the team remained vigilant for any signs of maternal or fetal compromise. The nursing staff prepared for possible neonatal resuscitation should the newborn face respiratory challenges immediately after birth. The overarching goal remained to deliver the baby safely while minimizing the risk of brachial plexus injury and ensuring maternal stability. This situation required the nursing team to use their clinical reasoning skills to anticipate and manage developing complications effectively, keeping both maternal and neonatal outcomes at the forefront of their care planning.

Section 2

As the delivery team continued to manage the shoulder dystocia, the obstetrician proceeded with the episiotomy, and the team noted a significant change in the patient's status. The fetal heart rate, which had briefly stabilized at 110 bpm, began to drop again, this time to 80 bpm, signaling worsening fetal distress. The mother’s blood pressure remained elevated at 155/98 mmHg, and her respiratory rate increased further to 32 breaths per minute, correlating with anxiety and possible pain escalation. The tingling in her hands persisted, despite attempts to guide her through breathing exercises. The nurse, recognizing the signs of maternal hyperventilation and the potential for respiratory alkalosis, encouraged deeper, slower breaths and considered the administration of supplemental oxygen to optimize both maternal and fetal oxygenation.

Meanwhile, the obstetrician, aware of the urgency, employed additional maneuvers such as the Rubin and Woods screw maneuver to relieve the dystocia. The team was vigilant in their observation, noting any maternal or fetal compromise that could necessitate a shift to an immediate cesarean section if these efforts failed. The nursing staff remained prepared for neonatal resuscitation, ensuring that equipment such as an infant warmer, bag-mask ventilation, and intubation supplies were readily available. They also prepared to administer medications like epinephrine or naloxone if required, depending on the newborn's status post-delivery.

Throughout this critical juncture, the nursing team was tasked with closely monitoring the maternal vital signs and fetal heart patterns, documenting any changes meticulously. They encouraged maternal cooperation and focused on effective communication to ensure the mother understood the gravity of the situation without exacerbating her anxiety. As the obstetrician prepared for a last-resort cesarean section, the team reassessed their interventions, considering the balance between the urgency of delivery and the potential risks involved with each maneuver. The situation demanded careful prioritization and rapid decision-making to optimize both maternal and neonatal outcomes.

Section 3

As the obstetrician continued to employ maneuvers to alleviate the shoulder dystocia, the team observed a change in the mother's status that warranted immediate attention. Her blood pressure began to rise further, reaching 165/100 mmHg, indicating a possible progression towards preeclampsia. Simultaneously, the fetal heart rate continued to decelerate, dropping to a concerning 70 bpm. The nurse quickly alerted the obstetrician to these developments, emphasizing the need for expedited delivery to prevent further fetal compromise. The mother's respiratory rate remained elevated at 30 breaths per minute, with persistent tingling in her extremities despite supplemental oxygen therapy. This clinical picture suggested the possibility of maternal exhaustion and the need for additional support.

Given the compounded stressors on both the mother and fetus, the obstetrician decided to proceed with an emergency cesarean section. The team swiftly prepared for the transition, ensuring the operating room was ready and that all necessary personnel were in place. The anesthesiologist was briefed on the situation and worked efficiently to administer spinal anesthesia, allowing for rapid surgical intervention. Meanwhile, the nursing staff maintained continuous monitoring of maternal vital signs and fetal heart patterns, documenting each change meticulously to provide a comprehensive overview of the ongoing situation. The team also communicated effectively with the mother, providing reassurance and clear explanations of the procedure to help manage her anxiety.

As the surgical team initiated the cesarean section, the nurse observed a significant decrease in maternal anxiety levels, likely due to the sense of relief that action was being taken. The mother's blood pressure began to stabilize at 150/95 mmHg, and her respiratory rate decreased to 28 breaths per minute, indicating a positive response to both the intervention and supportive care measures. The fetal heart rate, however, remained low, underscoring the critical need for expedited delivery to prevent potential neonatal complications. Throughout this intense period, the healthcare team demonstrated astute clinical reasoning, balancing the urgency of the situation with the need for careful monitoring and intervention, setting the stage for the next steps in managing the patient's care.

Section 4

As the cesarean section progressed, the surgical team successfully delivered the baby, who presented with cyanosis and poor muscle tone, indicative of a moderate neonatal respiratory distress. The Apgar score at one minute was 4, prompting immediate neonatal resuscitation efforts. The pediatric team quickly initiated positive pressure ventilation and administered supplemental oxygen. Within minutes, the baby’s color and tone improved, and the Apgar score increased to 7 at five minutes, suggesting a positive response to the interventions. Meanwhile, the obstetrician completed the delivery of the placenta and began to close the surgical site, while the nursing team continued to monitor the mother closely.

Postoperatively, the mother was transferred to the recovery room, where her vital signs were reassessed. Her blood pressure was noted to be 145/90 mmHg, and her respiratory rate had decreased to 24 breaths per minute. Despite these improvements, laboratory results soon revealed that her platelet count had dropped to 95,000/mm³, raising concerns for thrombocytopenia associated with preeclampsia. This necessitated ongoing monitoring and the consideration of magnesium sulfate therapy to prevent seizure activity, given the preeclampsia diagnosis.

The situation demanded careful clinical reasoning by the healthcare team to balance the management of preeclampsia with the need for ensuring optimal recovery from the cesarean section. Discussions were initiated regarding the need for a hematology consult to evaluate the thrombocytopenia further and to determine the best course of action for ongoing maternal care. The team also focused on supporting the mother emotionally, providing her with updates on both her condition and her newborn's progress in the neonatal intensive care unit. This multifaceted approach highlighted the complexity of care required in such scenarios, underscoring the importance of interdisciplinary collaboration in achieving positive outcomes for both mother and child.

Section 5

As the mother settled into the recovery phase, the nursing team conducted an initial assessment to ensure her stability. Despite the administration of magnesium sulfate, she began to exhibit signs of increasing respiratory distress, characterized by shallow breathing and an oxygen saturation level that had fallen to 88%. These findings were concerning, especially in the context of her existing hypertensive state and potential fluid overload from the surgical procedure. Her heart rate had also increased to 110 beats per minute, prompting further evaluation for possible pulmonary complications.

The clinical team immediately responded by adjusting her oxygen supplementation and elevating the head of her bed to facilitate easier breathing. In light of these developments, a chest X-ray was ordered to assess for any underlying pulmonary edema or other respiratory complications. Concurrently, the team reviewed her fluid balance, noting a positive fluid status that raised suspicions of pulmonary congestion. The decision was made to initiate diuretics cautiously, aiming to reduce the fluid overload while closely monitoring her response to this intervention.

These changes in her status required the healthcare team to refine their clinical reasoning, balancing the management of her preeclampsia with the emergent respiratory concerns. The interdisciplinary team, including specialists in obstetrics, internal medicine, and respiratory therapy, convened to optimize her care plan, emphasizing the need for vigilant monitoring and timely interventions. This collaborative approach was vital in addressing the new complications, ensuring both the mother’s safety and her progression towards recovery.