A nurse is caring for a patient in labor with a history of gestational diabetes and previous cesarean section, now experiencing stalled labor and signs of fetal distress. Which of the following interventions should the nurse anticipate as a priority to address the current clinical situation?

B) Prepare the patient for an emergency cesarean section.

A) Increase the rate of oxytocin infusion to strengthen contractions.

B) Prepare the patient for an emergency cesarean section.

C) Administer antihypertensive medication to manage elevated blood pressure.

D) Provide the patient with oral glucose to address her elevated blood glucose level.

A patient in labor with a history of gestational diabetes and previous cesarean section presents with stalled labor, fetal tachycardia, and elevated blood pressure. Which nursing intervention is most appropriate to prioritize at this time?

C) Prepare for a repeat cesarean section due to signs of fetal distress.

A) Increase the oxytocin infusion to enhance uterine contractions.

B) Administer a fluid bolus to address possible dehydration.

C) Prepare for a repeat cesarean section due to signs of fetal distress.

D) Administer an antihypertensive to lower the patient's blood pressure.

A pregnant patient at 39 weeks gestation presents with oligohydramnios and an occiput posterior fetal position contributing to labor dystocia. Her laboratory results indicate slightly elevated liver enzymes, with blood pressure readings consistently high and proteinuria present. The clinical team decides to initiate magnesium sulfate for seizure prophylaxis. What is the primary nursing intervention to monitor after starting this treatment?

A) Monitor for signs of magnesium toxicity, such as decreased deep tendon reflexes

B) Assess fetal heart rate continuously for signs of distress

C) Encourage the patient to ambulate to promote labor progression

D) Monitor the patient's input and output to prevent fluid overload

A pregnant patient at 38 weeks gestation is diagnosed with oligohydramnios and has elevated blood pressure with proteinuria. The fetal ultrasound shows an occiput posterior position. The patient is started on magnesium sulfate for seizure prophylaxis. Which of the following nursing interventions is most critical for ensuring maternal and fetal safety at this time?

A) Monitor deep tendon reflexes and urinary output closely.

B) Encourage the patient to ambulate frequently to promote fetal descent.

C) Administer oxytocin to enhance uterine contractions.

D) Apply continuous external fetal monitoring and encourage maternal rest.

A pregnant patient is scheduled for an urgent cesarean section due to worsening preeclampsia. The patient's blood pressure is 165/110 mmHg, and she is receiving magnesium sulfate therapy. Which of the following actions should the nurse prioritize to ensure the safety of the patient and the unborn child?

B) Prepare the patient for immediate transfer to the operating room.

A) Administer an additional dose of magnesium sulfate to prevent seizures.

B) Prepare the patient for immediate transfer to the operating room.

C) Contact the healthcare provider to reassess the antihypertensive medication plan.

D) Monitor the fetal heart rate for any further signs of distress.

A pregnant patient in her third trimester is undergoing a cesarean section due to severe preeclampsia with signs of fetal distress. Despite being on magnesium sulfate therapy, the patient's blood pressure is 165/110 mmHg, and she reports a headache and blurry vision. Which is the priority nursing intervention in this situation?

B) Administer an additional dose of antihypertensive medication as prescribed.

A) Increase the rate of magnesium sulfate infusion to control blood pressure.

B) Administer an additional dose of antihypertensive medication as prescribed.

C) Prepare the patient for immediate cesarean section to prevent eclampsia.

D) Notify the anesthesiology team to reassess the patient's pain management plan.

A patient in labor is displaying signs of possible HELLP syndrome with elevated liver enzymes and thrombocytopenia. During the cesarean section, which of the following interventions should the nurse prioritize to ensure patient safety given the current clinical findings?

B) Prepare for possible platelet transfusion due to the patient's low platelet count.

A) Monitor the patient's blood pressure closely and prepare antihypertensive medications.

B) Prepare for possible platelet transfusion due to the patient's low platelet count.

C) Assess fetal heart rate continuously for signs of distress.

D) Ensure oxygen supplementation is available to address respiratory changes.

A patient undergoing a cesarean section due to severe preeclampsia and potential HELLP syndrome shows a sudden increase in heart rate and respiratory rate after spinal anesthesia. What is the most appropriate initial nursing intervention?

C) Notify the anesthesiologist of the changes in vital signs immediately

A) Administer intravenous fluids to address potential hypovolemia

B) Increase the rate of oxygen supplementation to improve oxygenation

C) Notify the anesthesiologist of the changes in vital signs immediately

D) Prepare for possible intubation due to respiratory distress

A postpartum patient diagnosed with HELLP syndrome is experiencing decreasing platelet counts and elevated liver enzymes. Which nursing intervention should be prioritized to manage this patient's condition effectively?

C) Monitor for signs of bleeding and prepare for potential platelet transfusion.

A) Administer acetaminophen to reduce liver enzyme levels.

B) Encourage increased fluid intake to improve platelet production.

C) Monitor for signs of bleeding and prepare for potential platelet transfusion.

D) Increase dietary protein to support liver function.

A postpartum patient diagnosed with HELLP syndrome is being monitored for complications. Her platelet count has decreased to 85,000/mm³, and her liver enzymes are elevated. The healthcare team decides to administer a single unit of platelets. What is the primary nursing action to ensure the effectiveness of this intervention?

B) Assess for signs of improved coagulation and decreased bleeding tendency.

A) Monitor the patient's blood pressure every 4 hours.

B) Assess for signs of improved coagulation and decreased bleeding tendency.

C) Increase the patient's oral fluid intake to enhance liver function.

D) Encourage the patient to ambulate regularly to promote circulation.

Labor dystocia - Nursing Case Study

Pathophysiology

• Primary mechanism: Labor dystocia primarily results from uterine dysfunction, where ineffective uterine contractions fail to sufficiently dilate the cervix or progress labor, often due to inadequate muscle coordination or decreased contractility.

• Secondary mechanism: Another critical factor is cephalopelvic disproportion, where the fetal head is too large or misaligned to pass through the maternal pelvis, impeding descent and prolonging labor.

• Key complication: Prolonged labor due to dystocia can lead to maternal exhaustion, increased risk of infection, and fetal distress, necessitating close monitoring and potential intervention to ensure safety for both mother and child.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: Gestational diabetes, previous cesarean section

• Current medications: Insulin, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Prolonged labor

• Key symptoms: Exhaustion, decreased fetal movement, lower abdominal pain

• Vital signs: Blood pressure 140/90 mmHg, heart rate 110 bpm, respiratory rate 22 breaths/min, temperature 37.8°C

Section 1

The medical team decides to conduct a thorough initial assessment to determine the progress of labor and evaluate any potential complications. Upon examination, the cervix is found to be dilated to 6 cm, with minimal change over the past four hours, indicating a stalled labor. Uterine contractions remain irregular and weak, despite the administration of oxytocin to augment labor. Fetal heart monitoring reveals a baseline heart rate of 170 bpm with minimal variability, raising concerns about fetal distress. The patient's exhaustion is evident, and she reports intense lower abdominal pain with each contraction.

Given the patient's history of gestational diabetes and previous cesarean section, the situation is approached with caution. Blood glucose levels are checked and found to be elevated at 150 mg/dL, necessitating adjustments in insulin administration to manage maternal glucose levels effectively. The elevated blood pressure at 140/90 mmHg and the presence of mild proteinuria in a recent urine dipstick test suggest the possible onset of preeclampsia, adding complexity to the clinical picture.

These findings prompt the obstetric team to consider a multi-faceted intervention strategy. Close monitoring of both maternal and fetal status continues, with an emphasis on managing blood pressure and optimizing uterine contractions. The possibility of a repeat cesarean section is discussed with the patient, balancing the risks of continued dystocia and fetal compromise against the potential complications of surgical intervention. As the team evaluates the next steps, they remain vigilant for any signs of worsening fetal distress or maternal instability, preparing for a rapid response if necessary.

Section 2

As the clinical team delves deeper into the situation, they focus on the new diagnostic results to guide their next steps. A repeat fetal ultrasound is performed to assess amniotic fluid levels and fetal position. The ultrasound reveals a reduced amniotic fluid index, indicating oligohydramnios, which could further compromise fetal well-being. Additionally, the fetus is in an occiput posterior position, contributing to labor dystocia. This malposition, combined with the stalled cervical dilation and irregular contractions, presents a clear challenge in achieving a vaginal delivery.

Laboratory results show a slight increase in the patient's liver enzymes, with ALT levels rising to 45 U/L and AST levels to 42 U/L, heightening the suspicion of preeclampsia progressing. The patient's platelet count, however, remains within normal limits, offering some reassurance against severe complications such as HELLP syndrome at this point. Given the elevated blood pressure and proteinuria, the decision to initiate magnesium sulfate for seizure prophylaxis is made to reduce the risk of eclampsia.

In light of these diagnostic findings, the obstetric team discusses the implications with the patient and her family. The potential for fetal distress due to oligohydramnios and the suboptimal fetal position necessitates a reevaluation of the delivery plan. The team underscores the importance of addressing the maternal and fetal risks, considering an expedited cesarean section as the safest course of action. With the consent of the patient, preparations for the surgical intervention begin, emphasizing the importance of swift and coordinated efforts to ensure the well-being of both mother and child. As the team remains vigilant, they continue to monitor for any further deterioration in the patient's condition while ensuring she receives comprehensive care.

Section 3

As the clinical team prepares for the cesarean section, they continue to monitor the patient's vital signs and overall condition closely. During this period, a significant change in the patient's status is observed. The patient's blood pressure begins to rise further, reaching 165/110 mmHg, despite the initiation of magnesium sulfate therapy. The patient's reflexes are also noted to be brisker than before, with a 3+ deep tendon reflex response, indicating an increased risk of progressing to eclampsia. Additionally, the patient reports a persistent headache and blurry vision, both of which are concerning symptoms that warrant immediate attention.

Recognizing these developments, the team quickly reassesses the situation, acknowledging that the patient's condition is becoming increasingly unstable. The decision to expedite the cesarean section becomes even more urgent. They prioritize stabilizing the patient's blood pressure with additional antihypertensive medications while ensuring that magnesium sulfate levels are therapeutic to prevent seizures. The anesthesiology team is briefed on the patient's deteriorating condition to prepare for any complications during the procedure.

In parallel, the fetal heart rate monitor reveals signs of fetal distress, with late decelerations and decreased variability, confirming the need for prompt delivery. The clinical team communicates these critical findings to the patient and her family, reinforcing the necessity of the cesarean section to address both maternal and fetal risks. With the surgical team in place and all safety protocols reviewed, the patient is transferred to the operating room. The focus remains on delivering the best possible outcome for both mother and child, with continuous monitoring and support provided throughout the process.

Section 4

As the patient is transferred to the operating room, the clinical team remains vigilant in monitoring her condition. Despite the administration of antihypertensive medications, her blood pressure remains elevated at 160/105 mmHg. The anesthesiology team, aware of the risks associated with general anesthesia in a hypertensive patient, opts for a spinal anesthetic to minimize potential complications. However, as the anesthetic is administered, the patient's heart rate suddenly increases to 120 beats per minute, and she begins to exhibit increased respiratory rate and mild dyspnea. The team notes these changes and ensures oxygen supplementation is readily available to maintain adequate oxygenation.

Meanwhile, the obstetric team reevaluates the fetal heart rate monitor, which continues to demonstrate late decelerations and minimal variability, indicating ongoing fetal distress. The decision to proceed with the cesarean section is reaffirmed, and the surgical team begins the procedure with urgency. As they proceed, the patient's laboratory results are reviewed, revealing a slightly elevated liver enzyme level and a platelet count that has dropped to 95,000/mm³, raising concerns about the potential development of HELLP syndrome.

Throughout the surgery, the clinical team remains focused on maintaining hemodynamic stability and monitoring for any signs of bleeding, given the patient's thrombocytopenia. They prepare for potential interventions, such as platelet transfusion, should the patient's condition warrant it. The successful delivery of the infant, albeit with a low Apgar score, prompts the pediatric team to initiate immediate neonatal care. Post-delivery, the mother's blood pressure begins to stabilize, and her symptoms of headache and blurred vision show signs of improvement, suggesting a positive response to the interventions and the alleviation of the acute stressors associated with labor dystocia and impending eclampsia.

Section 5

Following the successful delivery and initial stabilization of the mother, the clinical team focuses on closely monitoring both her and the newborn for any emerging complications. Within the first hour postpartum, the mother's blood pressure continues to show a downward trend, reaching 140/90 mmHg, which is promising. However, her platelet count remains low, and the liver enzymes are further elevated, suggesting ongoing hepatic strain. The team decides to perform a comprehensive metabolic panel and a full blood count to gain a clearer picture of her current status. The results reveal a further decrease in platelet count to 85,000/mm³ and a slight increase in alanine transaminase (ALT) and aspartate transaminase (AST) levels, prompting concerns about the progression of HELLP syndrome.

The medical team discusses the need for a multidisciplinary approach to manage her condition effectively. Hematology is consulted to evaluate the necessity of a platelet transfusion, especially given the risk of further bleeding due to her thrombocytopenia. The decision is made to administer a single unit of platelets preemptively while continuing to monitor her coagulation profile closely. Additionally, the team increases the monitoring frequency of her vital signs, liver function tests, and urine output to catch any early signs of deterioration.

Simultaneously, attention is directed toward the newborn, who, despite the low initial Apgar scores, shows signs of improvement with oxygen supplementation and gentle stimulation. The pediatric team remains vigilant, keeping a close eye on the baby's respiratory efforts and oxygen saturation levels. The infant's condition gradually stabilizes, with an increase in oxygen saturation to 95%, indicating an effective response to the immediate interventions. The anticipated next steps involve ongoing neonatal support and further assessment for any underlying issues that may require intervention. As both mother and child remain under careful observation, the clinical team prepares for possible additional interventions while remaining optimistic about their recovery trajectory.