Amelia Sung VSIM Amelia Sung Maternity Case | Latest 2023/2024

Amelia Sung VSIM Amelia Sung Maternity Case | Latest 2023/2024 Which of the following pregnancy-related conditions increase the risk for shoulder dystocia?--Uncontrolled maternal gestational diabetes Rationale: Uncontrolled gestational diabetes leads to fetal macrosomia, fat pads at the fetal neck, and increased maternal weight gain, all factors that increase the incidence of shoulder dystocia. Preeclampsia and IUGR both result in smaller infants and thus do not increase the risk of shoulder dystocia. Hyperemesis, while it can continue throughout the pregnancy, is generally a problem of the first trimester and not related to the delivery. The nurse documents the following events: crowning at 0749, fetal head emerged at 0800, McRobert's maneuver performed at 0802, suprapubic pressure applied at 0806, and fetal body delivered at 0808. What is the significance of documenting these events?--Provides an indicator of the potential for fetal compromise Rationale: Documenting this sequence of events provides an indicator of the potential for fetal compromise related to decreased oxygenation. The time of birth is when the entire body is born. The focus is on the well-being of the mother and fetus/baby, not the team's response. The Apgar score is assigned using the standard criteria. The nurse has assessed that the patient in labor is at risk of shoulder dystocia. After delivery of the fetal head, the nurse states in a clear, loud voice, "Fetal heart rate 90 beats per minute with minimal variability." Why is it important for the nurse to communicate this information?--To inform the provider about the fetal status Rationale: A call-out is a clear and concise statement of data or an event that everyone on the health care team needs to know to care for the patient effectively. Changes in the FHR are not routinely announced in the delivery room, but in this situation the call-out by the nurse is important to give data to the provider so the provider can evaluate the fetal status and determine the next course of action. The patient is focused on pushing out the fetus, so the information is not for her benefit. The nurse's interpretation of routine fetal activity is documented in the patient's chart, not verbally. What is the first action by the nurse to assist with the delivery of the fetal shoulders and body when there is shoulder dystocia?--Flex the mother's thighs toward her abdomen Rationale: Flexing the legs toward the abdomen allows the pelvis to open to its maximum dimension. This position is used prior to application of suprapubic pressure. Fundal pressure will not dislodge the fetal shoulders from under the bone. Placing the mother's legs in stirrups enhances visualization but will not facilitate delivery of the fetus.