Swiftriver Maternity 2022(Maternity scenerio )

Jessica Wu, 35-year-old Asian female, G3 T2 P2 A0 L2, 35 weeks gestation. NKDA. Previous pregnancies uncomplicated but Cesarean births due to persistent breech position. Smoker x 15 years but states she "cut back to 3 cigarettes/day during her pregnancies." Reports that she started smoking during college. States started having moderate amount of bright red bleeding about 0800. Came to the hospital after dropping the older children at school (5 and 7 years old). She has called her husband and he is meeting her at the hospital because he was already at work. It is now 0945. She is anxious about the bleeding. States she "never had anything like this with her other pregnancies!" Denies pain, contractions, or leaking of amniotic fluid. Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Normal Psychological Needs- Increased Psychological Needs- Normal Kesha Jackson, Patient is a G1P0, gestational age of 33.1. She came in complaining of contractions for 2 hours that are now every 5 mins. She is unsure about rupture of membranes, denying vaginal bleeding and recent intercourse. She states the baby is active. She rates her pain an 8/10. Her current vital signs are 98.1 F, 36.7 C, 92 BPM, 16 breaths/min, 122/64 mmHg, 99% on room air. The fetal heart rate is 135 baseline but is not yet reactive. Cervical exam reveals that she is not dilated or effaced, and the baby's head is not engaged in the pelvis. She has no medical history and NKA. In obtaining her history, it was learned that she is 15 years old, currently homeless, and has been staying with various friends. She does have some supplies including diapers, wipes, and some clothing that she received from a friend. She expresses the desire to take her baby home with her. She is receptive to teaching and assistance she just has been unsure of how to obtain it. She came to the OB triage via a bus. Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Increased Psychological Needs- Increased Sensorium- Normal 00:18 01:15 Maria Sanchez, 20-year-old female, G1 P1 L1, 39 weeks gestation. Pregnancy uncomplicated. O+, Rubella immune, Group B Strep negative. NKDA. 12-hour 1st stage, 1 hour 2nd stage, 10 minute 3rd stage. Spontaneous vaginal delivery with 1st degree perineal laceration one hour ago. Vital signs stable; fundus firm, midline, at umbilicus; Lochia rubra moderate, no clots; Up to bathroom x1- 500 mL, no dysuria, instructed on peri-care; Legs still a little "tingly" but able to bear weight with assist X2. Pain level 3/10- ice to perineum with relief. Neonate male- Juan- 3500 g; Apgar 8 & 9; T 36.8 C, 98.2 F; AP 156 beats/minute, regular; R 52 breaths/minute, irregular. Skin-to-skin with mother for first hour. Beginning to show hunger cues. Their plan is do both breast and bottle feeding; "las dos cosas." Maria's husband Raul is a quiet presence. Her mother, grandmother, and older sister were Maria's support persons in labor. Maria and Raul are bilingual in English and Spanish. They were both born in the US- are Mexican Americans. Her mother speaks and understands more English than her grandmother does. Educational: Increased Fall Risk: Increased Health changes: Increased Pain Level: Increased Psychological Needs: Increased Sensorium: Normal Clara Guidry, Patient is a 34 y/o G5P4 who gave birth to a 9lb. 3 oz male infant following a 12-hour elective oxytocin induction of labor. She had an uncomplicated labor, epidural anesthesia and a rapid second stage, no episiotomy or perineal lacerations. Indwelling urinary catheter was removed prior to delivery. She is now one hour postpartum and is breastfeeding her baby. An IV of 1000 mL Lactated Ringers is infusing at KVO rate with an infusion of Lactated Ringers with oxytocin 20 Units infusing IVPB at 125 mL/hour. Upon entering her room, she tells you that she "feels wet", and may have urinated on herself since she is still numb from the epidural and unable to move legs. Your assessment reveals blood pooling under buttocks onto the underpads with numerous large clots. She is anxious, appears pale, and complains of feeling light-headed. Her husband is at her bedside. Educational: Increased Fall Risk: Increased Health changes: Increased Pain Level: Normal Psychological Needs: Increased Sensorium: Increased Clara Guidry, Patient is a 34 y/o G5P4 who gave birth to a 9lb. 3 oz male infant following a 12-hour elective oxytocin induction of labor. She had an uncomplicated labor, epidural anesthesia and a rapid second stage, no episiotomy or perineal lacerations. Indwelling urinary catheter was removed prior to delivery. She is now one hour postpartum and is breastfeeding her baby. An IV of 1000 mL Lactated Ringers is infusing at KVO rate with an infusion of Lactated Ringers with oxytocin 20 Units infusing IVPB at 125 mL/hour. Upon entering her room, she tells you that she "feels wet", and may have urinated on herself since she is still numb from the epidural and unable to move legs. Your assessment reveals blood pooling under buttocks onto the underpads with numerous large clots. She is anxious, appears pale, and complains of feeling light-headed. Her husband is at her bedside. Physiological: Acute Pain- False Bleeding- True Deficient fluid volume related to uterine atony/postpartum hemorrhage- True Impaired Mobility- True Impaired Patterns of Elimination- True Ineffective tissue perfusion related to hypovolemia- True Infection- False Nausea- False Safety: Deficient Knowledge- True Disturbed Sensory Perception- True Fall, risk for self and risk for dropping baby- True Impaired maternal newborn bonding- False Peripheral Neurovascular Dysfunction- False Jenny Theroit, 30 y/o G1P0 at 31 weeks' gestation. She has had an uncomplicated pregnancy until this morning when she woke up with clear fluid leaking from her vagina. She denies having contractions but says she isn't really sure what she is feeling. She presents to the Obstetrics Triage Unit, looking distraught and crying, and says she doesn't understand what is going on. Educational Needs- Increased Fall Risk- Increased Health Change- Increased Pain Level- Normal Psychological Needs- Increased Sensorium- Normal Jenny Theroit, 30 y/o G1P0 at 31 weeks' gestation. She has had an uncomplicated pregnancy until this morning when she woke up with clear fluid leaking from her vagina. She denies having contractions but says she isn't really sure what she is feeling. She presents to the Obstetrics Triage Unit, looking distraught and crying, and says she doesn't understand what is going on. Physiological: Acute Pain- False Anxiety-True Impaired mobility, risk for- False Impaired patterns of elimination- False Infection, Risk for-True Nausea-False Safety: Deficient knowledge- True Disturbed sensory perception- False Fall, risk for-True Risk for injury, maternal/fetal- True Jessica Wu, 35-year-old Asian female, G3 T2 P2 A0 L2, 35 weeks gestation. NKDA. Previous pregnancies uncomplicated but Cesarean births due to persistent breech position. Smoker x 15 years but states she "cut back to 3 cigarettes/day during her pregnancies." Reports that she started smoking during college. States started having moderate amount of bright red bleeding about 0800. Came to the hospital after dropping the older children at school (5 and 7 years old). She has called her husband and he is meeting her at the hospital because he was already at work. It is now 0945. She is anxious about the bleeding. States she "never had anything like this with her other pregnancies!" Denies pain, contractions, or leaking of amniotic fluid. Physiological: Acute Pain-False Decreased Cardiac Output- False Deficient Fluid Volume, risk for- True Ineffective tissue perfusion- False Injury, risk for fetal-True Safety: Fall Risk- True Injury, risk for maternal- True Love and Belonging: Anxiety- True Disabled Family Coping- False Fear- False Grieving, risk for- True Health Maintenance; Ineffective- True Kesha Jackson, Patient is a G1P0, gestational age of 33.1. She came in complaining of contractions for 2 hours that are now every 5 mins. She is unsure about rupture of membranes, denying vaginal bleeding and recent intercourse. She states the baby is active. She rates her pain an 8/10. Her current vital signs are 98.1 F, 36.7 C, 92 BPM, 16 breaths/min, 122/64 mmHg, 99% on room air. The fetal heart rate is 135 baseline but is not yet reactive. Cervical exam reveals that she is not dilated or effaced, and the baby's head is not engaged in the pelvis. She has no medical history and NKA. In obtaining her history, it was learned that she is 15 years old, currently homeless, and has been staying with various friends. She does have some supplies including diapers, wipes, and some clothing that she received from a friend. She expresses the desire to take her baby home with her. She is receptive to teaching and assistance she just has been unsure of how to obtain it. She came to the OB triage via a bus. Safety: Fall Risk- True Ineffective health maintenance- True Infection- False Knowledge Deficit- True Psychological: Anxiety- False Impaired home maintenance-True Noncompliance-False Risk for impaired parenting- True Physiological: Acute Pain-True Decreased cardiac output- False Impaired Mobility-False Nausea-False Risk for nutritional imbalance-True Maria Sanchez, 20-year-old female, G1 P1 L1, 39 weeks gestation. Pregnancy uncomplicated. O+, Rubella immune, Group B Strep negative. NKDA. 12-hour 1st stage, 1 hour 2nd stage, 10 minute 3rd stage. Spontaneous vaginal delivery with 1st degree perineal laceration one hour ago. Vital signs stable; fundus firm, midline, at umbilicus; Lochia rubra moderate, no clots; Up to bathroom x1- 500 mL, no dysuria, instructed on peri-care; Legs still a little "tingly" but able to bear weight with assist X2. Pain level 3/10- ice to perineum with relief. Neonate male- Juan- 3500 g; Apgar 8 & 9; T 36.8 C, 98.2 F; AP 156 beats/minute, regular; R 52 breaths/minute, irregular. Skin-to-skin with mother for first hour. Beginning to show hunger cues. Their plan is do both breast and bottle feeding; "las dos cosas." Maria's husband Raul is a quiet presence. Her mother, grandmother, and older sister were Maria's support persons in labor. Maria and Raul are bilingual in English and Spanish. They were both born in the US- are Mexican Americans. Her mother speaks and understands more English than her grandmother does. Safety: Fall Risk- True Injury, risk for maternal- True Physiological: Acute Pain- True Chronic Pain-False Ineffective breastfeeding, risk for- True Infection, risk for-True Love and Belonging: Anxiety- False Deficient Knowledge- True Readiness for Enhanced Parenting- True Clara Guidry, Scenerio 1 1. Assist mother to unlatch infant from breast and place infant in crib or hand to the husband. 2.Massage uterine fundus. Massaging the fundus until firm and tightly contracted closes off blood vessels at the placental site and stops bleeding 3.Call for help using emergency call system. 4.Set oxytocin rate to Bolus on IV pump as ordered by healthcare provider. 5. Assess bladder status and need to perform straight catheter. Clara Guidry, Scenario 2 1. Educate patient regarding indwelling urinary catheter placement, Wash hands. 2 .Insert indwelling urinary catheter and connect to collection bag, secure to patient's thigh. 3. Measure urine return in collection bag; Reassess uterine tone, response to massage, level in relation to umbilicus, and position in abdomen. 4. Reassess vaginal bleeding and presence for clots; change under pads as needed. 5. Wash hands, document findings and completion of procedure.