You are working as a Labor and Delivery Nurse at a local hospital. Patient A.M., a 26 year
old G3 P2 (2002) at 41 weeks of gestation came in having contractions and feeling uncomfortable.
Upon internal examination, the cervix was found to be 3 cm dilated. Fundic height was noted to be
40 cm. She was then admitted for monitoring of labor and delivery. She was initially advised to
continue mobilizing.
Obstetrical history was taken and documented. Her first baby was delivered 4 years ago via
normal spontaneous delivery with birthweight of 3,700 grams. The second baby was delivered 2
years ago via forceps delivery with birthweight of 3,900 grams. In this pregnancy, she was
diagnosed to have gestational diabetes mellitus at 28 weeks age of gestation. Pelvic ultrasounds
were normal and antennal care was unremarkable. The baby was moving actively normal prior to
labor.
Four hours later, spontaneous rupture of membranes occurred. She was examined again
and the cervix was still at 3 cm. An oxytocin infusion was started to augment labor with
cardiotocograph monitoring. After 4 hours, the cervix was 7 cm. After 4 hours again, internal
examination revealed 10 cm. She was then transferred to the delivery room.
She was encouraged to start active pushing and 30 minutes later, the head had crowned in
a occipito-anterior position. The midwife noticed that the head did not extend normally on the
perineum and that the chin appeared to be fixed in the perineum. She had attempted delivery of
the shoulders with the next three contractions but this had not been achieved.
You are working as a Labor and Delivery Nurse at a local hospital. Patient A.M., a 26 year
old G3 P2 (2002) at 41 weeks of gestation came in having contractions and feeling uncomfortable.
Upon internal examination, the cervix was found to be 3 cm dilated. Fundic height was noted to be
40 cm. She was then admitted for monitoring of labor and delivery. She was initially advised to
continue mobilizing.
Obstetrical history was taken and documented. Her first baby was delivered 4 years ago via
normal spontaneous delivery with birthweight of 3,700 grams. The second baby was delivered 2
years ago via forceps delivery with birthweight of 3,900 grams. In this pregnancy, she was
diagnosed to have gestational diabetes mellitus at 28 weeks age of gestation. Pelvic ultrasounds
were normal and antennal care was unremarkable. The baby was moving actively normal prior to
labor.
Four hours later, spontaneous rupture of membranes occurred. She was examined again
and the cervix was still at 3 cm. An oxytocin infusion was started to augment labor with
cardiotocograph monitoring. After 4 hours, the cervix was 7 cm. After 4 hours again, internal
examination revealed 10 cm. She was then transferred to the delivery room.
She was encouraged to start active pushing and 30 minutes later, the head had crowned in
a occipito-anterior position. The midwife noticed that the head did not extend normally on the
perineum and that the chin appeared to be fixed in the perineum. She had attempted delivery of
the shoulders with the next three contractions but this had not been achieved.
Make a Nursing Care plan on the client described in the Clinical scenario above.
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