Clinical Scenario #1 :Mikayla is a 27-year-old, G2 P0 at 38 weeks…

QuestionClinical Scenario #1 :Mikayla is a 27-year-old, G2 P0 at 38 weeks…Clinical Scenario #1: Mikayla is a 27-year-old, G2 P0 at 38 weeks gestation. She is being admitted for an induction of labor (IOL) for oligohydramnios. A sterile vaginal exam (SVE) shows her cervix is closed, 50% effaced, -2 station, firm and posterior. Noticing:  1.     What are the risks associated with oligohydramnios for Mikayla and her baby? 2.     Is it always necessary to perform a SVE prior to an induction of labor? Interpreting: 3.     What is Mikayla’s Bishop score based on these findings?       4.     How does a Bishop’s score help to determine which medication will be used for an induction of labor?    5.     The healthcare provider orders the following:Dinoprostone 10 mg vaginal suppository   6.     Which of the following conditions would the nurse notify the healthcare provider as a contraindication for the use of dinoprostone vaginal insert or gel?  Select all that apply1.     Late decelerations on the fetal monitor2.     Ultrasound at 34 weeks showed fetus in breech presentation3.     Presence of oligohydramnios4.     History of asthma5.     Pregnancy has not reached 40 weeks gestationInterpreting7.     After discussing her plan of care with the provider, Mikayla appears confused and asks the nurse “what is the purpose of me getting this medication and how will we know it’s working?” How should the nurse respond?8.     Compare and contrast the administration considerations that apply to dinoprostone vaginal insert and dinoprostone gel. Dinoprostone vaginal insert Dinoprostone gel        Responding9.     Mikayla understands and agrees to her plan of care involving dinoprostone insertion. For each potential nursing intervention, check to specify if the intervention should take place prior to administration, during, and/or after administration or not applicable (NA)  Nursing Interventions Before During After NA Monitor for uterine contractions, report increasing duration or strength of contractions ? ? ?  ? Monitor fetal heart rate ? ? ?  ? Assess client for contraindications ? ? ?  ? Encourage ambulation ? ? ?  ? Report nausea, vomiting, and diarrhea ? ? ?  ? Keep client NPO ? ? ?  ?  Mikayla received dinoprostone at 1800 and had mild irregular contractions throughout the night, but was able to sleep in short cycles. FHR was stable at 140 bpm and reactive, with no decelerations. The vaginal insert was removed by the provider at 0600. SVE showed her cervix at 1 cm, 80% effaced, -2 station, soft and now anterior. ReflectingPrepare change of shift report and note areas/gaps of knowledge in this scenario Clinical Scenario #2 Progression: Mikayla is a 27-year-old, G2 P0 at 38 weeks gestation who was admitted for an induction of labor (IOL) for oligohydramnios. She was given a dose of dinoprostone 10 mg vaginally at 1800. It was removed 30 minutes ago, after being in place for 12 hours. Her SVE at that time was 1 cm, 80% effaced, -2 station, soft and anterior.  Noticing: 1.     Why is it necessary to induce labor for oligohydramnios?    2.     What is Mikayla’s Bishop score? Is she a candidate for an induction of labor at this time?      Interpreting: 3.     The healthcare provider is considering an oxytocin drip to induce labor. What contraindications are there for the use of oxytocin?4.      Mikayla has no contraindications and the provider orders the following:·        Oxytocin (Pitocin) 30 units in 500 ml Lactated Ringers IV piggy back ·        Begin Pitocin at 2 milliunits/minute via infusion pump and may increase by 1 milliunit no more often than every 30 minutes until adequate contraction pattern is reached. ·        Do not exceed 20 milliunits/minute ·        Wait one hour after removal of dinoprostone to start oxytocin administration  5.     Calculate the gtt/min if starting oxytocin at 2 mu/min using the premixed IV bag (above). 6.     What instructions should be provided for a client taking oxytocin? Responding6.     For each of the following nursing interventions, check it would be a correct or incorrect intervention for a client receiving oxytocin.  Nursing Interventions Correct Incorrect ID client and verify medication order       Nurse verifies IV pump settings twice prior to starting infusion        Monitor maternal blood pressure and pulse rate       Monitor FHR and report signs of fetal distress       Have client remain on strict bedrest during induction         Monitor I & O and level of consciousness       Stop infusion if client complains of increased pain         Discontinue infusion of oxytocin once contractions every 2-3 minutes         What administration considerations apply to oxytocin? 7.     Explain uterine hyperstimulation and what nursing interventions would be necessary if this were to occur with a client receiving oxytocin. 8.     Assess each client’s status below and check appropriate intervention(s) Client statusContractions                Fetal heart rate                      Pt states Increase oxytocin Decrease oxytocin Maintain dose Stop infusion Notify MD Q 5-6 min                   130-no decel                     contractions stronger     Q 7-10 min                 100-no decel                  comfortable & talkative         Q 2 min                       130 with early decels           rectal pressure      Q 4 min                       120 with late decels               no complaints         Q 1-2 min                   140 with accels                   membrane ruptured           Q 4 min                     150 with variable decel            back pain       9.     Mikayla delivers her baby after 20 hours of oxytocin induction. Will she be more or less likely to need oxytocic medication in the immediate postpartum period/Stage 4? Why?  10. Reflect on content that was confusing or unclear.  Clinical Scenario #3 Progression: Mikayla is a 27-year-old, G2 P1 at 38 weeks gestation who was admitted for an induction of labor (IOL) for oligohydramnios. She received dinoprostone 10 mg vaginally X 12 hrs. and then was induced with oxytocin. She had a vaginal delivery, an 8 lb boy, over an intact perineum after 20 hours of labor. She is currently receiving oxytocin IV at 40 mu/min. She has been clinically stable and is about to be transferred to the postpartum unit after a two hour recovery period. She has gotten up to void once and had 50 mL of blood-tinged urine. Her fundus is firm at the umbilicus and has a small amount of dark red lochia. She is physically exhausted and has been anxious since delivery because her labor and delivery were harder than she ever expected. Last documented VS – T: (oral) 99.2o    BP: 110/67  P: 95 bpm  R: 18   O2 sat: 98%  Last documented Assessment: GEN’L APPEARANCE: Resting in bed, appears uncomfortable, restless RESP: Breath sounds clear bilaterally, non-labored respiratory effort CARDIAC: Pink, warm & dry, heart sounds regular with no abnormal beats, pulses palpable. NEURO: Alert and oriented X 4 BUBBLE-HE BREAST: UTERUS: BLADDER: BOWELS: LOCHIA: HOMANS: EPISIOTOMY:   Lactating; soft, non-tender with evidence of colostrum Right of umbilicus, slightly boggy. 2 fingerbreadths above umbilicus Voided 50 ml after delivery, bladder distended Abdomen soft/nontender, bowel sounds audible per auscultation in all 4 quadrants Rubra. Soaked entire peri pad with 10-12″ diameter puddle of blood weight= 450 mL Negative Perineum intact      Noticing:1.     What assessment data is relevant and must be recognized as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance: GENERAL APPEARANCE: Appears uncomfortable, restless   CARDIAC: Pink, warm/dry, no edema, heart sounds regular with no abnormal beats, equal with palpation at radial/pedal/post-tibial landmarks    UTERUS: Right of umbilicus, slightly boggy, palpable bladder BLADDER: Voided 50 ml after delivery, bladder distended    LOCHIA: Rubra. Soaked entire peri pad with 10-12″ diameter puddle                 2.     What is the primary problem that your patient is most likely presenting with?    Interpreting: 3.     What is the underlying cause/pathophysiology of this primary problem? Responding  4.     Which Orders Do You Implement First and Why?   Care Provider Orders: Order of Priority: Rationale:         5.   What contraindications are there for the use of methylergonovine?                 6. What are the therapeutic uses for methylergonovine?  7.     What administration considerations apply to methergine?   Reflecting:Based on what you have learned about uterotonic medication, how do you explain why oxytocin is used before methergine. Health ScienceScienceNursingShare Question

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