ScenarioP.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test, and she reports that the result was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician.1. What are the 2 most important questions to ask to determine possible pregnancy?2. You ask whether she has ever been pregnant, and she tells you she has never been pregnant. How would you record this information?3. What additional information would be needed to complete the TPAL recordPer the clinic protocol, you obtain the following for her prenatal record: Complete blood count, blood type with Rh factor, urine for urinalysis (protein, glucose, blood), vital signs, height, and weight. In addition, the pregnancy is confirmed with a blood or urine hCG test and an ultrasound. Next, the nurse-midwife performs a physical examination, which includes a pelvic examination. The examination and tests confirm that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks’ gestation.4. Do any of these vital signs cause concern? What should you do?5. P.M. tells you that the date of her last menstrual period (LMP) was February 2. How would you calculate her due date? What is her due date?You are the charge nurse working in labor and delivery at a local hospital. P.M. arrives, reporting contractions and feeling somewhat uncomfortable. You take her to the triage room to provide privacy, have her change into a gown, and begin your assessment to determine your next course of action.P.M.’s contractions are 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). She tells you that she is in her 39th week and she is due to deliver in 3 days. Before performing a vaginal exam, you would need to ask PM. addition information.6. What additional information do you need?On examination, P.M. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit.7. What nursing measures should be done at this time?As part of your assessment, you review the fetal heart rate strip pictured here.8. Based on the findings, what is your intervention?9. Identify the stage of labor P.M. is experiencing.CASE STUDY PROGRESSAlthough D.H. continues to use alternative therapies for discomfort, she asks for pain medication and receives a dose of meperidine (Demerol). She is also placed on an oxytocin (Pitocin) infusion.10. What is the purpose of the oxytocin infusion?a. To reduce pain.b. To stimulate uterine contractions.c. To prevent maternal hypertension.d. To increase cervical effacement and dilation.11. Decelerations occur in an early, variable, or late pattern. What is the significance of these patterns?12. State what the nurse should do for each type.
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