Case Study: Intrapartum Interventions, Complications and Cesarean Section
Gloria is a 25-year-old G4P3003 at 30 weeks of gestation who was brought to the emergency room after a motor vehicle accident. She was seated in the passenger seat as the car was hit on the passenger side by another vehicle traveling perpendicular to her car in an intersection. The paramedics report that she was not wearing a seatbelt. Upon arrival to the emergency department, the paramedics report that her vital signs are: T 98.6 P 132 R 20 BP 90/40. An IV of LR is infusing in her left forearm. Gloria is awake and alert. She reports abdominal, chest, and leg pain.
Question 1 What are the priorities of care in this case?
Question 2 What additional specific nursing interventions are indicated due to the pregnancy?
Question 3 Gloria is stabilized and thoroughly evaluated for maternal injuries with negative findings. Her vital signs have stabilized. A bedside ultrasound reveals normal findings of an appropriately sized fetus in vertex position with a normal amount of amniotic fluid. There is a small amount of vaginal bleeding and contractions are noted every 5 minutes, which Gloria perceives as cramping. A vaginal exam reveals the cervix to be 2 cm dilated and long, with the vertex at -3 station. The physician has ordered betamethasone 12 mg IM q 24 hours × 2 doses. What is the purpose of this medication?
Question 4 The physician also has ordered nifedipine 10 mg q 6 hours. What is the purpose of this medication?
Question 5 The police report of the motor vehicle accident confirms that Gloria was not wearing a seatbelt and also reports that Gloria's husband, the driver, had an elevated blood alcohol level and had gone through a red light when the accident occurred. Gloria's blood alcohol and urine drug screen were negative. How should the nurse address these findings with Gloria?