CASE STUDIES
1. LABOR & DELIVERY HIGH RISK
Chapter 21: Nursing Management of Labor and Birth at Risk
1. Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC. (Learning Objective 9)
A. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat caesarean delivery.
B. Laura can't understand why more women don't want to try a VBAC delivery. Discuss the possible reasons for this.
C. Describe the management of care for a woman attempting a VBAC delivery.
2. Carol, age 17, is pregnant with her first child. Her menstrual dates are accurate and her date of conception is limited to one possible day. Her physician gives her an EDC of March 28th. Carol has gone past her due date and refuses to have her labor induced. Carol states, "My grandmother says that the baby will come when it is good and ready." It is now April 14thand Carol is at 42 3/7 weeks' gestation. She calls the office and reports that she is having a significant lower backache and she just passed "a glob of bloody mucus" from her vagina. (Learning Objective 5)
A. Discuss the risks a prolonged pregnancy places on Carol.
B. What risks are there for Carol's unborn baby?
C. Describe the nursing care required for women in labor with a prolonged pregnancy.
2. POST PARTUM HIGH RISK
Chapter 22: Nursing Management of the Postpartum Woman at Risk
1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6)
1. What are the "four T's" that need to be assessed in a possible case of postpartum hemorrhage?
2. Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?
2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)
1. Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
2. What additional questions do you want to ask her to try to ascertain the cause of her fever? Describe the care required to treat each of these infections.