Nurse Documenting Events Assignment Help: How to Answer This Question

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Structure your response with introduction, analysis, and conclusion.

Key Explanation

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Original Question

The nurse is documenting the events that just took place at the patient bedside. Complete the sentences. Provider at perineum, notes ( Select : purulent discharge ,meconium stool , prolapsed cord OR cephalopelvic disproportion at vaginal introitus. ) An urgent cesarean section due to the fetus presenting (Select : frank breech , persistent occiput posterior position , fetal hand preceding the fetal head OR asynclitism ) called at 1532. Image transcription text Intrapartum and Postpartum Care of Cesarean Section Birth Families Scenario The nurse is caring for a patient in OB triage in active labor. Use the chart to answer the questions. The chart may update as the scenario progresses. History an… Show more HISTORY AND PHYSICAL ASSESSMENT: Medical/Surgical history: Patient is a 29-year-old African American female, G4P2012, at 39.5 weeks. EDD is 4/03/XX based on first trimester ultrasound. Patient is compliant with prenatal appointments and care recommendations, and has had no complications with pregnancy. First pregnancy 5 years ago: IVF pregnancy. SVD at 40.3, first degree laceration, no other complications, 3,285 g viable female. Second pregnancy 3 years ago: IVF pregnancy. SVD at 38.6 weeks, no complications, 3,420 g viable male. Third pregnancy 18 months ago: IVF pregnancy. SAB at 10 weeks, unknown pathology. Social history: Nonsmoker, nondrinker, no history of drug use. Is an elementary school teacher. States marriage is stable and happy with no concerns. Wife is an active-duty naval officer, currently deployed in the Mediterranean. Has family in the area for support, including two sisters and her parents. Family History: Maternal and paternal history of hypertension. Paternal hyperlipidemia. Maternal depression, well controlled with medication. No other concerns. Physical Assessment: Pre-pregnancy—height 5’11”, weight 168 lb, BMI of 23. Current weight 194 lb. NST is reactive, FHR baseline 140 bpm with contractions every 2 to 4 minutes, moderate intensity on palpation. SVE 5/80/0, membranes intact. NURSINGS NOTES 4/01/XX 1428 Patient ambulated to OB triage with sister at her side. States contraction pain woke her around 0630 this morning, but labored at home until they became more frequent. 1450 Provider contacted with report and recommendation for admit. Patient admitted to labor and delivery unit per provider orders. Patient ambulated to room, oriented to room and care plan. Placed on FHM, US above umbilicus on the right side. 18-gauge INT placed in RFA (right forearm), CBC and type cross labs drawn and sent to lab. 1510 Patient states she felt a gush of fluid during a contraction. Pericare performed. Fluid noted to be clear and copious. 1528 Patient states she feels the urge to push. Provider notified and room prepared for delivery. 1532 Provider at bedside. Patient is open glottis, involuntarily pushing. Tarry, black discharge is noted at the vaginal introitus. The provider palpates the presenting part, and calls for an urgent cesarean section. VITAL SIGNS: 4/01/XX 1445 Temp 98.4°F (36.9°C) HR 82 beats/min; regular RR 22 breaths/min SpO2 100% on room air Blood pressure 123/69 mm Hg Pain 0 on 1-10 scale when not contracting, 7/10 during contractions

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