A laboring client has been diagnosed with shoulder dystocia and a decision has been made to perform the McRoberts maneuver. What is the primary goal of this intervention in the context of shoulder dystocia?

C) To change the angle of the pelvis and facilitate fetal descent

A) To increase the frequency of uterine contractions

B) To reduce maternal blood pressure

C) To change the angle of the pelvis and facilitate fetal descent

D) To alleviate the mother's lower abdominal pain

A laboring patient is diagnosed with preeclampsia and shoulder dystocia. Magnesium sulfate therapy has been initiated to prevent seizures, and maneuvers are being performed to resolve the dystocia. Which nursing intervention is most critical in this scenario to ensure maternal and fetal safety?

A) Monitor deep tendon reflexes and respiratory status closely.

B) Prepare for immediate cesarean delivery without further delay.

C) Administer a bolus of intravenous fluids to stabilize blood pressure.

D) Apply fundal pressure to expedite delivery.

A laboring patient is experiencing shoulder dystocia with variable decelerations in the fetal heart rate. The healthcare team has implemented the McRoberts maneuver and applied suprapubic pressure without success. The patient's blood pressure remains elevated, and she has developed a fever. What is the most critical nursing action at this point?

B) Prepare the patient for an emergency cesarean section.

A) Administer an additional dose of antihypertensive medication.

B) Prepare the patient for an emergency cesarean section.

C) Increase the rate of the magnesium sulfate infusion.

D) Provide the patient with a cool compress to reduce fever.

A nurse is caring for a mother experiencing shoulder dystocia during labor. The team has performed the McRoberts maneuver and applied suprapubic pressure, but the fetal head remains in the same position, and the fetal heart rate shows concerning variable decelerations. What should be the nurse's priority action to address the current situation?

B) Prepare the mother for an emergency cesarean section.

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

B) Prepare the mother for an emergency cesarean section.

C) Administer additional antihypertensive medication to manage the mother's blood pressure.

D) Encourage the mother to change positions to alleviate fetal distress.

A pregnant woman with a history of elevated blood pressure and magnesium sulfate infusion is being prepared for an emergency cesarean section. She suddenly experiences increased pain, shortness of breath, and a sense of impending doom. Her heart rate is 120 bpm, and oxygen saturation is 92% on room air. Which nursing intervention should be prioritized in this situation?

B) Administer supplemental oxygen to improve oxygen saturation.

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

B) Administer supplemental oxygen to improve oxygen saturation.

C) Prepare for immediate neonatal resuscitation due to fetal distress.

D) Request a stat chest X-ray to assess for pulmonary complications.

A pregnant patient is being prepared for an emergency cesarean section due to fetal distress and maternal complications. She suddenly experiences severe pain, shortness of breath, and a drop in oxygen saturation. Her magnesium level is at the upper therapeutic limit. What is the nurse's priority action to ensure patient safety?

A) Administer supplemental oxygen and notify the anesthesiologist.

B) Increase the rate of magnesium sulfate infusion to manage pain.

C) Prepare for immediate neonatal resuscitation.

D) Delay surgery until laboratory results are further reviewed.

A postpartum patient who underwent an emergency cesarean section due to suspected chorioamnionitis is experiencing elevated blood pressure and tachycardia. She is currently on magnesium sulfate therapy. What is the priority nursing intervention to address her condition?

B) Administer prescribed antihypertensive medication.

A) Increase the rate of magnesium sulfate infusion.

B) Administer prescribed antihypertensive medication.

C) Encourage the patient to ambulate to reduce blood pressure.

D) Monitor the patient's fluid intake and output closely.

A nurse is caring for a postpartum patient who had an emergency cesarean section due to suspected chorioamnionitis. The patient's blood pressure is elevated, and she is receiving magnesium sulfate therapy. What is the nurse's priority action in managing this patient?

C) Notify the healthcare provider of the elevated blood pressure immediately.

A) Continue to monitor the patient's blood pressure every 4 hours.

B) Administer the next dose of magnesium sulfate as scheduled.

C) Notify the healthcare provider of the elevated blood pressure immediately.

D) Increase the IV fluid rate to help stabilize blood pressure.

A postpartum mother, who underwent a cesarean section and has a history of chorioamnionitis, is exhibiting signs of respiratory distress with a respiratory rate of 28 breaths per minute and diminished breath sounds in the right lung base. A chest X-ray reveals bilateral infiltrates consistent with pulmonary edema. What is the priority nursing intervention for this patient?

C) Initiate oxygen therapy at 2 L/min via nasal cannula.

A) Administer a diuretic as prescribed to reduce fluid overload.

B) Position the patient in a sitting position to facilitate lung expansion.

C) Initiate oxygen therapy at 2 L/min via nasal cannula.

D) Notify the healthcare provider of the patient's deteriorating condition.

A postpartum mother who recently underwent a cesarean section is exhibiting signs of respiratory distress with a respiratory rate of 28 breaths per minute and diminished breath sounds in the right lung base. A chest X-ray reveals bilateral infiltrates consistent with pulmonary edema. What is the most appropriate initial nursing intervention to address the mother's respiratory status?

B) Position the mother in a high Fowler's position.

A) Administer supplemental oxygen via nasal cannula.

B) Position the mother in a high Fowler's position.

C) Prepare for immediate intubation and mechanical ventilation.

D) Encourage the mother to perform incentive spirometry.

vaginal delivery - Nursing Case Study

Pathophysiology

• Primary mechanism: Uterine contractions - Coordinated contractions of the uterine muscles, triggered by the hormone oxytocin, facilitate the descent and expulsion of the fetus through the birth canal.

• Secondary mechanism: Cervical dilation - The cervix softens, thins, and dilates in response to hormonal changes and fetal pressure, allowing the fetus to pass through during delivery.

• Key complication: Shoulder dystocia - This occurs when the fetal shoulders become lodged behind the maternal pubic symphysis after the head is delivered, potentially leading to brachial plexus injury if not managed promptly.

Patient Profile

Demographics:

28-year-old female, registered nurse

History:

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

• Current medications: Prenatal vitamins, insulin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Labor pains and difficulty in delivery

• Key symptoms: Prolonged labor, mild fever, lower abdominal pain

• Vital signs: Blood pressure 145/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 100.4°F

Section 1

As the labor progresses, the obstetric team conducts an initial assessment to evaluate the current status of both the mother and the fetus. Upon examination, the cervix is found to be 8 cm dilated and 90% effaced, indicating significant progress but still short of full dilation. The fetal head is engaged, but there is a noticeable delay in further descent, raising concerns about fetal positioning and potential shoulder dystocia. Fetal heart rate monitoring reveals a baseline of 170 bpm with occasional late decelerations, suggesting potential fetal distress. The mother continues to report intense lower abdominal pain, consistent with the uterine contractions, but the prolonged labor raises concerns for exhaustion and increasing maternal stress.

Given the elevated blood pressure of 145/95 mmHg and persistent mild fever, the healthcare team considers preeclampsia as a potential complication, compounded by her history of gestational diabetes. Laboratory tests are ordered to assess liver function, kidney function, and coagulation profiles, with particular attention to platelet count and proteinuria. The results indicate elevated liver enzymes and trace proteinuria, supporting a diagnosis of preeclampsia. The team decides to initiate magnesium sulfate therapy to prevent seizures, alongside antihypertensive medication to manage elevated blood pressure.

With the confirmed diagnosis of shoulder dystocia, the team prepares for an immediate intervention. The obstetrician performs the McRoberts maneuver, a standard technique to resolve shoulder dystocia by hyperflexing the mother's legs tightly to her abdomen, which can help change the angle of the pelvis and facilitate delivery. Additionally, suprapubic pressure is applied to aid in dislodging the fetal shoulder. These maneuvers, combined with continued monitoring and support, are critical in managing the current situation and preventing further complications. The team remains vigilant, prepared for potential escalations, including an emergency cesarean section if necessary, as the labor progresses.

Section 2

As the healthcare team implements the McRoberts maneuver and applies suprapubic pressure, they closely monitor both maternal and fetal responses to the interventions. The fetal heart rate, which had previously shown occasional late decelerations, now presents with a more concerning pattern of variable decelerations, indicating umbilical cord compression likely exacerbated by shoulder dystocia. The fetal heart rate fluctuates between 160 and 180 bpm, with continued variability, necessitating enhanced vigilance and prompt decision-making.

In response to the interventions, the mother's vital signs are reassessed. Her blood pressure remains elevated at 150/100 mmHg despite the antihypertensive medication, and her fever has risen to 38.5°C (101.3°F), pointing towards a possible developing infection or chorioamnionitis. Her pain level remains high, and she exhibits signs of increasing fatigue and anxiety, further complicating the clinical picture. The magnesium sulfate infusion is closely monitored, with serum magnesium levels drawn to ensure therapeutic but not toxic levels, as the mother reports experiencing mild nausea and warmth, common side effects of the medication.

Despite the maneuvers, the fetal head remains in the same position, confirming the severity of the shoulder dystocia. Given the lack of progress and the potential for fetal compromise, the team discusses the need for an emergency cesarean section. The decision to proceed is made swiftly to prevent further deterioration of both maternal and fetal conditions. The team prepares the mother for surgery, coordinating efforts to ensure a rapid yet safe transition to the operating room, highlighting the critical importance of timely intervention in preventing adverse outcomes in such complex obstetric cases.

Section 3

As the team prepares to transport the mother for an emergency cesarean section, her condition begins to further complicate. While being moved to the operating room, she experiences a sudden increase in pain intensity, rated at 9 out of 10, which is accompanied by a new onset of shortness of breath and a sense of impending doom. Her heart rate accelerates to 120 bpm, and oxygen saturation drops to 92% on room air. These changes prompt immediate reassessment and escalate concerns about possible pulmonary edema or other cardiovascular compromise, particularly given her history of elevated blood pressure and ongoing magnesium sulfate infusion.

Laboratory results return just as the team is about to proceed with surgery, revealing a white blood cell count of 18,000/mm³, supporting the suspicion of an infectious process potentially involving chorioamnionitis. Additionally, the recent serum magnesium level is at the upper limit of therapeutic range at 2.5 mmol/L, necessitating careful monitoring to avoid toxicity, especially in the context of her altered respiratory status. Urgent coordination with anesthesia and neonatology teams is initiated to prepare for potential complications during delivery, including the need for neonatal resuscitation, given the persistent fetal heart rate abnormalities.

In the operating room, the healthcare team implements a rapid sequence induction, ensuring the mother is stable for the surgical procedure. The anesthesiologist remains vigilant for signs of magnesium toxicity, while the obstetrician prepares for a potentially challenging delivery, given the shoulder dystocia and fetal distress. The collaborative efforts focus on optimizing both maternal and fetal outcomes, highlighting the critical interplay of timely clinical decisions and multidisciplinary teamwork in managing this high-risk obstetric scenario.

Section 4

As the surgical team initiates the emergency cesarean section, the obstetrician notes that the amniotic fluid is cloudy and foul-smelling, further supporting the suspicion of chorioamnionitis. This observation underscores the potential for maternal infection complicating the delivery process. Meanwhile, the anesthesiologist monitors the mother's vital signs closely, noting that her heart rate has increased to 130 bpm and her blood pressure is now elevated at 160/95 mmHg. This change raises concerns about the potential for hypertensive crisis, especially given her history and ongoing magnesium sulfate therapy.

During the procedure, the fetal heart rate pattern continues to show significant variability with recurrent late decelerations, prompting the neonatology team to prepare for immediate neonatal resuscitation. Despite the challenging conditions, the team successfully delivers the infant, who exhibits poor tone and an initial Apgar score of 4 at one minute. Immediate interventions include clearing the airways, stimulation, and positive pressure ventilation, which result in a gradual improvement of the infant's condition, reflected in an Apgar score of 7 at five minutes. This progression emphasizes the importance of coordinated efforts and prompt response to the evolving clinical picture.

Post-delivery, the mother's condition stabilizes somewhat with her oxygen saturation improving to 95% on supplemental oxygen, but her blood pressure remains a concern, necessitating further antihypertensive management. The laboratory team confirms an elevated C-reactive protein, reinforcing the need for broad-spectrum antibiotics to address the infection. The healthcare team's ongoing vigilance and dynamic problem-solving exemplify the critical nature of real-time clinical reasoning in managing acute obstetric emergencies, setting the stage for continued monitoring and care in the immediate postpartum period.

Section 5

As the team shifts focus to the postpartum care of both mother and infant, the mother's condition warrants close monitoring due to the ongoing risk of complications. Despite initial stabilization, the mother begins to exhibit signs of increasing respiratory distress. Her respiratory rate climbs to 28 breaths per minute, and auscultation reveals diminished breath sounds in the right lung base, raising the suspicion of pulmonary edema or aspiration pneumonia, especially given the recent cesarean section and the history of chorioamnionitis. A chest X-ray is promptly ordered, which reveals bilateral infiltrates consistent with pulmonary edema. The rapid response team is activated to assess the need for potential transfer to the intensive care unit for further respiratory support and monitoring.

Simultaneously, the infant, now in the neonatal intensive care unit, shows signs of persistent tachypnea and mild grunting, suggestive of transient tachypnea of the newborn (TTN) or possible early onset neonatal sepsis due to the maternal infection. Blood cultures are drawn, and the neonate is started on empirical antibiotic therapy. Continuous positive airway pressure (CPAP) is initiated to assist with breathing, given the infant's labored respiratory efforts and oxygen saturation dipping to 88% on room air. These interventions lead to a gradual improvement in the infant's respiratory status, with oxygen saturation increasing to 93% on minimal CPAP support.

The evolving clinical picture for both mother and infant underscores the importance of interdisciplinary collaboration and ongoing assessment. The healthcare team must continue to integrate new diagnostic data and response to interventions into their care plans, remaining vigilant for any further complications. This continued vigilance is crucial to navigate the complexity of postpartum management and ensure the best possible outcomes for both mother and child.