Labor and Delivery Clinical Written Assignment
Please choose four of the case study topics below to answer. Each topic should take a minimum of half page to answer.
Mrs. Johnson is a G2P1 @ 38 weeks gestation presenting to L&D at 11 am with a report of painful contractions. Her membranes ruptured on admission with clear fluid. Admission VS were T 37.6 C, P 91, R 20, and B/P 134/76. Prenatal group beta strep (GBS) testing is unknown, however she tested GBS+ with her last pregnancy and her firstborn did not show signs of GBS disease. Mrs. Johnson states she does not understand her treatment plan, which includes antibiotics for GBS prophylaxis. Mrs. Johnson would like to decline any unnecessary interventions including the antibiotics. What would you say to Mrs. Johnson?
Mrs. Jackson is a G7P6 with a known placenta previa. This is Mrs. Jackson's seventh girl and she and her husband would like to try again for a boy. Mrs. Jackson is scheduled for a repeat cesarean section at 39 weeks' gestation. Mrs. Jackson is a Jehovah's Witness. Mrs. Jackson has been counselled regarding her potential need for blood during her surgical procedure. She is declining all blood products due to her religious beliefs and has written a letter stating this which has been placed on her chart. What potential complications can you anticipate for Mrs. Jackson at her delivery?
Mrs. Tillman is a G5P4 at 39 weeks. She is being induced for LGA with an estimated fetal weight of 4500 grams. Upon admission, Mrs. Tillman is noted to be 3 cm dilated and 80% effaced. Pitocin is ordered for her induction agent. Mrs. Tillman dilates slowly and is finally complete after 36 hours on a Pitocin infusion. What potential complications of delivery can you anticipate for Mrs. Tillman?
Mrs. Kaur is a 32 yo G4P0 @ 23 weeks gestation. Mrs. Kaur is a graduate of Harvard. She and her husband have made it clear that they do not want a child with a disability of any kind. She is admitted for an elective termination of a pregnancy for a non-lethal fetal anomaly. How do you feel about this and what do you do?
Miss Smith is a 16 year old G1P0 who presents with complaints of not feeling the baby move for several hours and SROM on admission @ 40 5/7 weeks. The fluid is greenish in color. The patient arrives alone and has no family support with her. The baby's father is not in the picture. You are unable to find fetal heart tones. An IUFD is confirmed by the physican with an ultrasound. The obstetrician tells Miss Smith he is sorry, but her baby has died in utero. The doctor leaves and Miss Smith asks you if something is wrong. What do you do and what do you say?
Mrs. Yee is a 28 year old G1P1 who delivered 18 hours earlier. She is trying to breastfeed but is highly anxious, and because she is unable to determine the amount of milk her baby is getting with each feed, she states that she is afraid she is not producing any milk. What education would you provide for this patient?
Mrs. Kim is a 38 year old G3P2. She tells you that someone had come to her room to perform a lab test, but the person was called out of the room and said they would be back shortly. She does not understand the purpose of the test. You determine the test is the California Newborn Screening. What education and information do you provide to Mrs. Kim regarding the screening?
Mrs. Jones is a 24 year old G2P1 who delivered a term infant earlier in the day. She is blood type O-. You enter her room with her rhogam injection, and she states "there is no need for me to get that. I'm not having anymore babies." What education and information do you provide Mrs. Jones regarding rhogam and the indications for giving it to her?
Ms. Innes is a 42 year old patient with a history of infertility who used IVF to have a baby on her own. She had planned an all-natural childbirth with minimal interventions. After an induction for postdates which lasted 2 days, Ms. Innes developed chorioamnionitis, the fetal heart rate tracing showed a non-reassuring pattern before a 10 minute deceleration to the 60's and Ms. Innes had an emergent cesarean section under general anesthesia. Ms. Innes appears depressed on her second postpartum day and says to you "nothing went the way I wanted it to. I didn't get anything I wanted or the birth experience I wanted". Ms. Innes' baby is in the NICU for observation to rule out sepsis. What do you say to Ms. Innes? What else would you do in caring for Ms. Innes?