1.  Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical exam. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 2, 6, and 9)

1. Based on the vaginal assessment, identify the stage of labor and appropriate nursing interventions for this stage of labor.
2. Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor?
3. Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?

2.  Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced and +2 station.  She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations.  Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended.  (Learning Objectives 4 and 5)

A.  What is happening to Emily’s baby at this point in time?  What does this mean?

B.  What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?

Chapter 15: Postpartum Adaptations

1.     You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 2 and 3)

1. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
2. Linda wants to know how long she should expect to bleed. What would you tell her?
3. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

2.     Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 4)

A.   Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding.

B.    What nursing interventions could you implement that would assist Sam in the transition to fatherhood?