Answer Happy

Mrs. Jones is a 36 y/o G 3 P2 came into triage stating she was contracting every 5 minutes and lasting for 45-60 seconds for the past hour. She denies ROM and she is GBS neg. Melissa RN is a new graduate nurse and takes Mrs. Jones to triage to monitor her. Melissa applies the electronic fetal monitor externally. This is the strip Melissa notes when she comes into triage: Early decelerations Describe what you see. Define the variability, type of decelerations (which it tells you), how far apart are the contractions are, and how long they last. Melissa takes her to a labor room. The doctor comes in and examines her. The following are her vitals and the assessment of her labor. . BP 113/64 • P 74 • R 16 • Dilated -5 cm, station 0, effacement 80%
Melissa starts an IV of Lactated Ringers and the IV is at 125 cc/hr. Two hours go past and Mrs. Jones is handling her labor well and her husband is helping her through the contractions. Melissa checks her and the following are the vitals and cervical exam: . BP 118/70 • P76 • R 16 • Dilated 7-8 cm, +1 station, and is 100% effaced. Here is her fetal monitoring strip: What is being shown on the monitoring strip? Define the type of deceleration do you see. Examine the contraction pattern. What are the frequencies and durations? What interventions should be done at this time? What type of contraction pattern is this? What is the resting tone? Is it enough for the baby to recover from the contractions? What does Melissa report to the doctor? Mrs. Jones's labor is being monitored very closely, she is now Melissa's only patient. One hour has passed and Mrs. Jones is complete, +1 and strong contractions. She begins to push. Melissa has called the doctor and he is on his way to the
One hour has passed and Mrs. Jones is complete, +1 and strong contractions. She begins to push. Melissa has called the doctor and he is on his way to the hospital. When Mrs. Jones is pushing Melissa notices Mrs. Jones is displaying "the turtle sign". What does that mean? The doctor comes in and watches Mrs. Jones push. He realizes that she has shoulder dystocia. What is that? The baby's head is out, but she cannot push the shoulders out. What are the interventions that need to be made for Mrs. Jones to deliver vaginally? How much time does the doctor have to deliver the baby without permanent damage to the baby? The baby delivers at 17:08 and weighs 7# 1 oz. 18 inches long. The baby is doing well and has an APGAR of 7 at 1 minute and 8 at 5 minutes. The baby goes to Mom for skin-to-skin. Both mom, dad, and baby go to postpartum after recovery.