Labor and Delivery Amelia Sung vSim PDF

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Labor and Delivery Amelia Sung vSim Maternity...

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CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Labor and Birth: During the normal laboring and birthing process, a patient must go through three different stages to finally meet her newborn. The first stage of labor is first phase she must go through and is considered to be the longest stage of them all. For this reason the first stage is divided into two phases: latent and active. The latent phase begins when the patient starts to feel their first true and regular contractions and ends with the patient being at least 6 cm dilated. During the phase, the contractions are 5-10 minutes apart, lasting about 30-45 seconds, and effacement is from 0-40%. The patient remains talkative during this phase. The second phase begins when the patient is 6 cm dilated and ends with full dilation (10 cm). During the active phase the patient's contractions increases and intesifies and she limits interactions with the people around her. The second stage of labor begins from the 10 cm dilation to the birth of the fetus. During this phase the patient goes through active pushing in which she feels rectal pressure from the presenting part and has the urge to push. The last stage of labor begins with the birth of the newborn and ends with the separation and birth of the placenta. There is fourth stage, however, the fourth stage is not considered to be a true stage of labor. During all stages of labor, is crucial to monitor the patient and the fetus

DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) During the laboring and birthing process the only diagnostic test there is a cervical exam. The cervical exam allows the nurse to know how many cm the patient has dilated and determine the process of labor. Other possible diagnostic tools is the external monitor that monitors the fetus. That monitor will allow monitoring that can possibly indicate some type of fetal distress.

PATIENT INFORMATION Amelia Sung is a 36 year old female patient who was admitted to the labor and delivery unit for an induction of labor. She is 39 weeks gestation. She is receiving two different medications: lactated ringer running at 125 mL/hr and oxytocin running at 20 mU/min and another oxytin at 1 mL/ 1 mU. Upon admission a cervical exam was done and she was 2 cm dilated, 80% effaced, and -1 station with vertex fetal presentation. At 01:00 she was 4 cm dilated, 100% effaced, and remains at -1 station. She received an epidural shortly afterwards and her membranes had ruptured which was clear. She was fully dilated and started pushing three hours ago.

ANTICIPATED PHYSICAL FINDINGS Cervical dilation Cervical effacement Contractions

ANTICIPATED NURSING INTERVENTIONS During the laboring process the most important interventions that must be done is monitoring and assessing both the patient and the fetus. Constant monitoring of the contractions and fetal heart rate are important to identify any potential complications such as decelerations. Other nursing interventions include assisting the patient to reposition to decrease contraction pain, administer medications such as pain medications, and assisting in ambulation if needed.

vSim ISBAR ACTIVITY INTRODUCTION

STUDENT WORKSHEET Hello this is Laura, RN, calling from the labor and delivery unit

Your name, position (RN), unit you are working on

SITUATION

Amelia Sung is a 36 year old female patient who was admitted for an induction of labor.

Patient’s name, age, specific reason for visit

BACKGROUND Patient’s primary diagnosis, date of admission, current orders for patient

Ms. Sung was admitted 24 hours ago at 39 weeks gestation to be induced for labor. She was started on oxytocin at 1 mL/1 mU, lactated ringer running at 125 mL/hour, and another oxytocin infusion at 20 mU/min. She has a first-born male who was delivered 3 years and 3 months ago, vaginally. He weighed 7 lb 6 oz and measured 55 cm.

ASSESSMENT Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

RECOMMENDATION Any orders or recommendations you may have for this patient

Upon admission a cervical exam was done and showed she was 2 cm dilated, 80% effaced, and at -1 station with fetus in vertex presentation. At approximately 01:00 she was 4 cm dilated, 100% effaced, and remains at -1 station. Shortly afterwards, she received an epidural and her membranes ruptured which was clear. About 3 hours ago she became fully dilated and started pushing, however, she was getting tired and the fetal head was descending slowly. The fetal heart rate was 120/min with moderate variablity, and signs of early decelerations. Within the last few contractions, the fetus has started to crown, the provider was called, and came in to assist with the patient. Vital signs were: Assess maternal vital signs Assess fetal heart rate as there is a signs of early decelerations Obtain vital signs

PHARM -4- FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION: Oxytocin

CLASSIFICATION: Oxytocics

SAFE DOSE OR DOSE RANGE, SAFE ROUTE IV: 0.5-1 mU/min and increase rate by 1-0 mU/min at 30-60 minute interval IM: 10 units/mL

PURPOSE FOR TAKING THIS MEDICATION The purpose of this medication is help stimulate the laboring process. If the patient has a hard time progessing with the laboring process, oxytocin can be administered and increased overtime to help with the labor.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION As with all medications the most important aspect the nurse must take is to explain the reason to taking the medication. By explaining the purpose of the medication, it will allow the patient to know the risks and benefits that comes with the medication. It will also allow the patient to comply with the medication as it is a medication that helps induce and speed the process of labor. Another important factor that nurse must educate on is the adverse reactions that can arise with taking the medications. The possible adverse effects include site irritation, nausea, bledding, blurred vision, difficulty speaking, wheezing, itching, and swelling. This is important because it allows the patient to monitor and be able to report any of these if they appear.

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION and CLASSIFICATION

MEDICATION:

CLASSIFICATION:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

PURPOSE FOR TAKING THIS MEDICATION

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Instructor Feedback:

Clinical Worksheet Date:02/12/2021 Initials: A.S Age: 36 M/F: FEMALE

Student Name: Laura Bautista-Gomez Diagnosis: Labor and Birth (normal)

HCP: N/A

Length of Stay: 24 hours

Consults: NICU and charge nurse

Code Status:

FULL CODE

Allergies: Shellfish

Assigned vSim: Amelia Sung

Isolation: IV Type: Peripheral Critical Labs: NO PRECAUTIONS N/A Location: CONTACT PRECAUT Right forearm Fall Risk: N/A Fluid/Rate: Lactated ringer running at 125 mL/hr Transfer: Oxytocin at 1 mL/1 Mom was not mU and at 20 transferred, but baby

Other Services:

N/A Consults Needed: N/A

Why is your patient in the hospital (Answer in your own words and include the History of present Illness): My patient was admitted 24 hours ago to the labor and delivery unit for an induction of labor at 39 weeks gestation. Patient is in standard precautions

Health History/Comorbidities (that relate to this hospitalization): My patient has had three pregnancy in total with 1 preterm and 1 living children. She gave birth a boy vaginally 3 years and 3 months ago. He weighed 7 lb 6 oz and measured 55 cm.

Shift Goals/ Patient Education Needs: 1. Monitor patient vital signs to prevent any abnormalities 2.

Monitor fetal heart rate to further assess early decelerations

3. Educate patient on what shoulder dystocia is and the process that goes into delivering and proper treatment 4. Administer oxygen according to the provider Path to Discharge: For a successful discharge, monitoring and assessing the patient is a crucial aspect in the care plan to idenfity any abnormalities that can be treated early. Late identification can lead fetal compromise or maternal compromise that can complicate the treatment of both individuals.

Path to Death or Injury: Late identification and not frequently monitoring can lead to complications that can ultimately lead to injury to either individual.

Clinical Worksheet Alerts: What are you on alert for with this patient? (Signs & Symptoms) Dizziness or faintness 1.

Management of Care: What needs to be done for this Patient Today? Obtain vital signs according to the the provider orders 1.

2. Onset of fever

2. Administer oxygen for non-reassuring fetal heart rate

Abnormal uterine fundus 3.

3. Collaborate with other team members to care for the newborn 4.

What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) Assess for any bleeding which is most common during the third stage of labor 1. 2. Assess the amount of time of when the membranes rupture as it can increase risk for infections 3.

Assess that the fundus is midline and firm. Boggy fundus can increase the risk for bleeding

5.

1.

Brachial plexus injury

Position the patient according the charge nurse orders

6. Encourage the patient to push Priorities for Managing the Patient’s Care Today 1. Obtain vital signs according to the the provider orders 2. Administer oxygen for non-reassuring fetal heart rate 3.

List Complications that may occur related to dx, procedure, comorbidities:

Educate the patient on what is happening during her labor process

Collaborate with other team members to care for the newborn

Educate the patient on what is happening during her labor process, position the 4. patient according the charge nurse orders, encourage the patient to push

2. Fracture to the clavicle of the newborn 3. Lack of oxygen

What nursing or medical interventions may prevent the above Alert or complications?

1. Monitor the baby and the position that it is being born the provide support when the baby comes out. 2. Support the newborn when the head is being delivered thereby preventing a fracture to the collarbone. 3. Administer oxygen to the mom to also provide oxygen to the fetus to prevent any brain damage. 4.

In general, when a fetus has signs of being born with shoulder dystocia the

What aspects of the patient care can be Delegated and who can do it? Some aspect of the patient care that can be delegated is encouraging the patient to push. The rest of the patient care plan must be done by the RN themselves as it pertains to assessment.

Reflection Questions Paste your reflection questions in the box below How did the simulated experience of Amelia Sung's case make you feel? This scenario made me feel like I was not prepared for the process that goes in delivering a baby, especially a baby being born in shoulder dystocia. This scenario had some changes throughout the scenario and at some points I was not sure what else to do but to wait for the delivery nurses order when helping in birthing the baby. Describe the actions you felt went well in this scenario. The factors that went well in this scenario is obtaining the vital signs, checking the IV site, auscultating the patient’ s lung, assessing the deep tendon reflexes, preparing the delivery table, and bringing in the basinet. Scenario Analysis Questions* EBP What risk factors specific to shoulder dystocia were identified in Amelia Sung's case? Some risk factors would be gestational diabetes, prolonged second stage of labor, and estimated fetal weight of 4000 grams PCC/I Prioritize your nursing actions for Amelia Sung based on your assessment. For Amelia’ s case priorities would be begin with obtaining baseline vital signs that can be compared with future vital signs to identify any change that can indicate further treatment. Auscultating the patient’ s lungs to assess her breathing, assessing the deep tendon reflex, and calling the NICU and charge nurse once it showed signs of shoulder dystocia. The key element here is to call the NICU and charge nurse so that the NICU team can be prepared to care for the newborn. The charge nurse should also be notified as they are the ones responsible apart from the nurse to make sure that everything goes accordingly to provide proper care. EBP List potential problems for Amelia Sung and her baby related to the shoulder dystocia. Some potential problems may include a fractured arm, fractured clavicle, nerve damage, or possible asphyxiation. T&C List the interprofessional health care team that should be involved in Amelia Sung's case. The interprofessional teams that were involved in the care of Amelia is the NICU team and the charge nurse. Other teams that should have been involve would be the delivery nurse and an obstetrician. All interprofessional teams are important as it allows more eyes on both the baby and mom and allow proper treatment. S/QI/I Consider what points might be included in a safety checklist for shoulder dystocia. Some safety checklists would include maneuvers and procedures to aid the physician and mother in being able to deliver the baby. Others include assessing the position of the fetal head compared to the vaginal canal. Concluding Questions Reflecting on Amelia Sung's case, were there any actions you would do differently? Explain. There would be no actions that I would have done differently, however, it remains important to continuously monitor the patient as changes can occur at any point. Describe how you would apply the knowledge and skills that you obtained in Amelia Sung's case to an actual patient care situation. This scenario helped me learn new factors that important to take when it comes to delivering a baby, especially if there is shoulder dystocia present. It offers great presentation and details that should be taken into action for a shoulder dystocia. Good teamwork and proper management are all important to deliver a healthy baby.

Reflection Questions Paste your reflection questions in the box below

Rubric for Grading vSim Clinical Worksheet 5 Patient Information:

3

1

0

All documented areas 100% complete and provide thorough information.

Three listed areas completed OR documented areas 75% complete.

Less than three listed areas completed OR documented areas less than 50% completed.

Patient information area blank.

100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information.

75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario.

50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy.

25% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information not relevant, or content areas left blank,

Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete.

Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present.

Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present.

Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present.

Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present.

Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario.

Missing patient education and/or patient shift goals. Patient shift goals lack all components of SMART goals. 25% of the information needed for worksheet area present. Pathway to death and health contains information not relevant or accurate to the scenario or section left blank.

Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present.

Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present.

Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is present.

Missing 4 or more areas on worksheet. Answers not relevant to scenario. 25% of the information needed for worksheet area is present.

Management of Care relevant to case scenario and detailed. Priorities for scenario identified. Identifies all aspects of care that can be delegated and identifies appropriate personnel to delegate activities to. Answers detailed, Critical thinking evident.

Management of Care, Priorities or delegation sections relevant to scenario. Answers generic to situation. Some evidence of critical thinking present.

Missing relevant data in one or more categories (management of care, prioritization, delegation). Answers basic without detail. Little to no evidence of critical thinking present.

Information provided not relevant to scenario. Answers are basic without detail. No evidence of critical thinking. Missing answers in one or more area.

Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults

5

Medical History: Why patient is in the hospital, History of present Illness, Past Medical/Surgical History, Comorbidity Factors

5

Patient Education/Goals: Shift Goals, Patient Education Needs

5 Disease Progression: Pathway to Death or Inj...