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Labor Progression Case Study (45 min)

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A 27-year-old female who is 40 weeks and 2 days pregnant, with contractions occurring once every 10 minutes. The patient is checked in, vital signs are normal, fetal heart tones are normal and the mother and father to-be are settled into their room for the night. It is 4 am and the call light goes off. The patient reports she is feeling contractions every 2 minutes now and she thinks her water may have broken.

Critical Thinking Check
Bloom's Taxonomy: Application

How can the nurse find out if the patients water has broken?

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Critical Thinking Check
Bloom's Taxonomy: Comprehension

What color should the test be if the membranes have ruptured?

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The nurse prepares to test the fluid that has leaked down the patients’ leg. The test comes back positive for amniotic fluid. The nurse informs the doctor and prepares the patient to deliver.

Critical Thinking Check
Bloom's Taxonomy: Application

What is the most important thing to have ready at this time?

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The nurse is prepared for the delivery and is talking the mother through her breathing, the cervix is dilated to 7 cm and the contractions are now 1 minute apart.

Vital signs are as follows:

RR 30 bpm

HR 125 bpm

BP 110/67 mmHg

Fetal HR 133 bpm

The nurse checks the presentation of the baby and notes the baby head is in the vertex position, the bottom is in the frank position and baby is in the -1 station.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What station number means the baby is starting to come out?

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Critical Thinking Check
Bloom's Taxonomy: Comprehension

What cardinal movement is the baby currently in?

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The nurse monitors mom and baby for another hour and upon re-checking the position of the baby the nurse notes that the baby is now +1 station and the cardinal movement is descent and flexion.

Critical Thinking Check
Bloom's Taxonomy: Application

What does the nurse need to make sure has happened?

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As the baby is delivered the occiput is facing the right side of the pelvis and towards the front.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What position is the newborn in at delivery?

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