On an early Tuesday morning Patient Y, a 42-year-old Hispanic woman, arrived at the maternity unit for a scheduled induction. An induction is defined as, “the stimulation of uterine contractions by medical or surgical means before the onset of spontaneous labor” (Ricci, 2013, p. 727). She was 40 weeks and two days. She was a multigravida with two previous vaginal deliveries and one prior cesarean section (C-section). The reason the physician scheduled her to be induced was because she was of advanced maternal age and a multigravida. Patient Y’s past medical history included: included depression, breast disorder, obesity, acanthosis nigricans, varicella, and an abnormal pap smear. In regards to her GYN/OB history she had two previous vaginal …show more content…
The nurse immediately started to intervene by turning the patient onto their left side. This intervention did not work; therefore the nurse turned the patient onto her right side and applied 10L of oxygen to the patient via a facemask. Also, the nurse opened her fluids wide. After turning the patient from side to side the fetal heart rate returned to normal. This initial decel lasted four minutes and had a nadir (lowest point) of 85bpm. As this was happening the physician and two residents came into the room, because the fetal heart monitor alarms at their station as well. Once the fetal heart rate was back to normal the physician asked the nurse to continue monitoring the patient closely. The fetal heart rate remained stable for about thirty minutes until 8:20am when the heart rate began to have late decels. A late decel is defined as “A late decel is defined as “a gradual (onset to nadir >30 seconds) decrease in FHR, with the onset, nadir, and recovery of the deceleration occurring after the beginning, peak, and ending of the contraction, respectively” (Miller, 2012). The nurse began to intervene again by turning the patient, applying an oxygen mask at 10L, and opening the fluids to run wide. This time the nadir reached 50bpm and the physician knew he needed to act fast. At 8:34 the physician artificially ruptured the patient’s membranes and applied a fetal scalp electrode. “This …show more content…
While in the PACU, the nurse performed several post-delivery assessments including: vital signs, lochia amount and color, status of the uterine fundus, and bladder status. These assessments were performed every 15 minutes for the first hour and every 30 minutes for the second hour. Patient Y’s assessments remained within the normal limits. Her vital signs were appropriate throughout her time in recovery, besides her pain score being a 10 out of 10. Even though her pain was severe, it was considered “normal” for her circumstances. In order to reduce her pain, the nurse administered IV Dilaudid every five minutes. She had minimal amount of bleeding and her fundus was firm, midline and at the umbilicus. The nurse drained 700mL of urine from her foley bag prior to transferring the patient to her postpartum room. Patient Y did not fully awaken until about 30 minutes into her recovery due to general anesthesia. Upon awakening in the recovery room, Patient Y was truly concerned about her baby’s condition. At this time the nurse did not have an update on the newborn, therefore she explained to the patient that the Neonatologist would be over shortly to give her a complete analysis of her baby’s condition. After two hours of being in the recovery room, Patient Y was transferred to He postpartum room where she would stay for 72 hours. As mentioned previously, the newborn was
Darien is a patient who possibly displays comorbidity. His symptoms lead me to believe that he could possibly be diagnosed with obsessive-compulsive disorder and generalized anxiety disorder. Darien’s symptoms that point to OCD are that he has rituals he must complete and if he does not he becomes anxious and is unable to continue with his day. He is however aware that these rituals are not actually helping him but he cannot stop doing them. He also reports feeling anxious most of the day, especially if he cannot perform his rituals, and that he is becoming increasingly more anxious. He is also unable to keep himself from worrying and feeling anxious.
A 61-year-old gentleman was admitted on 25/1/2016 to Letterkenny General Hospital with central chest pain after history of a fall. He also had drastic weight loss and loss of motor and sensory function. He walks with the aid of a walking stick as he has problems walking due to his lower limb weakness. The patient was a heavy smoker of 90 pack years (3 packs/day for 30 years) and stopped nine years ago. He stopped drinking seven years ago. He is married and lives at home with his wife. He works as a plasterer. He has a strong family history of ischaemic heart disease and type 2 diabetes mellitus. Two of his brothers had coronary bypasses and stents. His father died of a myocardial infarction. Two of his brothers are also type 2 diabetics. During
relaxed and indicated that she had no pain prior to her discharge to the ward.
Patient sent to nurse's station for blood and urine test (5-10 minutes) with little wait.
Bethanie is a 32yo, G2 P0100, who is currently 11 weeks 3 days as dated by LMP consistent with a 6-week scan. She is known to our office from her prior pregnancy early in 2016. She was followed in our office for diabetes and had had a normal anatomic survey. About one week later she presented with cramping for a couple of days and on arrival she was noted to be 1 cm dilated and 90% effaced. The bag of os was noted to be at the external os. Because of her cramping an amniocentesis was performed which was negative for overt infection and a rescue cerclage was placed. Unfortunately, about one week later her water broke and she ultimately delivered a nonviable fetus. She did have chorio on placental pathology by the time of delivery. She does report that despite this history of possible type 2 diabetes that she has not required any medication and she had an early 1-hr glucose this pregnancy that was negative. She also has some fairly significant social issues as she is currently in the middle of separating from her husband due to domestic violence. She is here today to discuss her history in her prior pregnancy as well as possible FTS.
Therefore, even though the family wants Amanda to be taken off of ventilation that is not what is best for the fetus. So someone that has full capacity and competence has to make the decisions for the fetus and that is the doctors. Ali Nyima, a doctor specialized in obstetrics, said,” A pregnant woman who has been diagnosed as brain dead is considered dead, and somatic support is justified only to design appropriate strategies for the sake of the fetus.” Therefore, Ali Nyima supports the decision of keeping Amanda on ventilation system for the sake of the
...e baby still seems to have too much fluid in his or hers mouth or nose, the nurse may do further suctioning at this time. At one and five minutes after birth, an Apgar assessment will be done to evaluate the baby's heart rate, breathing, muscle tone, reflex response, and color. If the baby is doing well, the mother and the baby will not be separated. The nurse will come in from time to time to change diapers, check the babies temperature, and perform other tasks while the baby spends time with his or her mother and father (B. C. Board).
Patient number 1 has a normal ABG except for the PaO2, which is 229. The FIO2 is way too high and should be decreased.” Although supplemental oxygen is valuable in many clinical situations, excessive or inappropriate supplemental oxygen can be deleterious”(Sawatzsky, D. 2016). The question is how far should the FIO2 be decreased. I would titrate the FIO2 down by ten every hour, and watch the patients pulse oximetry to ensure the patient does not desaturate.
As the title suggests, a “pushed” birth is one that is unnecessarily induced, and/or managed, with an abundance of unjustifiable intrusions. The title of the book describes the feelings of many American women who feel “pushed” into making drastic decisions – decisions that they may not be emotionally prepared for. Block expresses that the title of her book came long before she even wrote it (Block, 2007, page xiii). Through her many conversations with expectant mothers, she would often hear them express a desire for a non-interventional and natural birth. Unfortunately, many women “felt tremendous pressure from their medical providers to go against instinct and … to induce labor, to schedule a cesarean, to lie back during labor when every cell in their body felt like moving. Women are supposed to push their babies out; instead, they felt they were being pushed around” (Block, 2007, page xiii).
The patient was transferred into my care via the Emergency Assessment Unit for Surgical Patients (EAUS). I was given handover by the charge nurse who has already pre-a...
This clinical rotation I was assigned to the operating room, where they conduct obstetric surgical procedures. Since, I had been sent to observe in the operating room before, during the previous semester, I was more at ease. Especially, already knowing what the role of a nurse would be during the procedure. There were four operation scheduled for that day, three of which I was able to observed. Even though there must have been a thousand scenarios of what might possibly go wrong were playing through my head, everything went well with each procedure. There were two hysterectomy, one caesarian birth procedure, and one laparoscopic tubal ligation performed, all of which except the caesarian birth I observed. Thus, I was a bit disappointed having missed the process of birth. However, the experience of having to work with a nurse that was not only very accommodating, but very intent on making sure that I gain knowledge
For the patient with medications follow up, the patient was 69-year-old female, her hypertension medication was lowered from 50 mg losartan to 25mg on her previous visit because she was having dizziness with 50mg of losartan. At this visit, she brought her BP machine from home to compare with our office BP machine. Also, I encouraged her to continue checking her BP at home regularly. In addition, her BP at home was less than 140/90. Patient was concerned that her BP was too high. I provided assurance and educated her that new guidelines say that BP less than 150/90 in adults 60 years and older requires no medical intervention. Also, her BMI was 19. I encouraged her to eat nutrient rich food that includes fresh fruits, vegetables and milk products. I educated about nutritional supplements such as boost or ensure and avoiding any diet restrictions. For the patient with Pap, she was having pelvic pain, along with regular pap test, I ordered BV, chlamydia and Gonorrhea, and UA. Also, the patient was complaining of peri menopausal symptoms, so I ordered FSH. I encouraged her on safe sex practices and self-breast exam. I ordered
So, I told my doctor I wanted to be induced. After all, my due date was only two weeks away and only five percent of women give birth on the day determined by their doctors. When I was finally there, I looked at the outside, the hospital was set in a suburban – like area, and when I went inside the building, I was in a welcoming ultramodern facility. I went straight to the labor and delivery section where they said my doctor had gone out of town; nobody believed that I was supposed to be induced that day. It took them like 15 minutes to confirm what I had told them, to finally decide to take me to a room to connect all kinds of tubes to my body. I went into the room; it looked very comfortable, but it was freezing. I lay on the typical hospital bed, one of those that make sleeping and resting easier.
Technology has had a very prominent influence on electronic fetal monitoring since its appearance in the 1960’s and 1970’s. For many years, fetal monitoring was simply done by listening to a fetal heartbeat through a stethoscope. Dramatic changes in the heartbeat, such as a long period or a drop in the rate or intensity, could be detected,. Now, not only is the electronic fetal monitor used on the outside of the womb by strapping electrodes to the mother’s abdomen but electrodes can also be inserted during the first stage of labor and placed directly on the baby’s head. With advanced technologies such as this the acidity of the infant’s blood as well as the heart rate can be measured.
If a pregnant female came into the ER and had a CBC ran showing a low platelets count,