SITUATION:

Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that she had been having contractions at 7-to-10-minute intervals since 4 p.m. They lasted 30 seconds. She also stated that she had been having ""a lot of false labor"" and hoped that this was ""the real thing"". Her membranes were intact. Mrs. M.'s temperature, pulse and respirations were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular. The nurse examined Mrs. M. and found that the baby's head was at +1 station, and the cervix was 4 cm. dilated and 80 percent effaced. She reported her findings to the doctor and he ordered Demerol 50 mg. with Phenergan 25 mg. to be given intravenously when needed.

Answer the following questions with detailed explanation:

1. Do you think Mrs. M. is in false labor? Give reasons for your answer.

2. As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that you would after this occurs? Why?

3. After her membranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55 seconds. They were moderately strong. Why is it important for Mrs. M. to relax during her contractions? How can you help her to relax?

4. When do you think Mrs. M. should be given the medication ordered by the doctor? What safety measures should be taken at the time the medication is given? What observations should be made after it is given? Why? What observations would you report to the doctor?

5. How would you know that Mrs. M. has entered the transition phase?

6. A vaginal exam revealed that Mrs. M. is done and +2. What should be the nursing interventions at this time?"

Here's a detailed response to each of the questions based on Mrs. M. 's situation:

  1. They would like to know if Mrs. M. is in false labor? Do explain on why you have given your answer.

 Assessment of Labor:

 - Contraction Frequency and Duration: Mrs. M. continues to have contractions at 7-to-10-minute intervals, each 30 seconds in duration, that could be early labor or even falsely perceived contractions if monitored with continuous Electronic Fetal Monitoring. However, contractions in false labor are often irregular and the pattern does not increase in terms of rhythm as well as the frequency.

 - Cervical Changes: On initial assessment Mrs. M. ’s cervix is found to be 4cms dilated and 80% effaced. This is suggestive of active labour since in most cases, dilatation beyond 3 cm is sign of active labour not false labour.

 - Fetal Heart Tones: The fetal contracting tones are also within the normal limit and are equally spaced meaning the fetus is intact well with the contractions.

 Conclusion: Mrs. M,expressed having lot of false labor pains in the past but basing on the findings of this study she is in true labor not false. Every student knows cervical change in the form of cervical dilation and effacement bring near to delivery.

  2. This is a tragicomic real life story of a woman identified as Mrs. M, as she was going to sleep her water breaking. Of the following actions what would be the first to take place as soon as this happens? Why?

 Initial Actions:

 - Assess Amniotic Fluid: Observe the following characteristics of the amniotic fluid: color, quantity and smell. Iatrosolious clear is expected whereas meconium-stained or smelling foul fluids may signify downwards evolution of the condition.

 - Monitor Fetal Heart Tones: It is thus important that FHTs should be monitored continuously following membrane rupture because rupture is known to increase the chance of umbilical cord compression.

 - Assess for Signs of Prolapsed Cord: If the fluid is green or the fetal heart tones are irregular check for an umbilical cord prolapse which may be an emergency.

 Reason: The primary concern is maintaining the well-being of the fetus and exclude such adverse outcomes as a cord prolapse or infection.

  3. Following the rupture of her membranes her contractions were coming every 4 minutes and lasting for 45 to 55 seconds. They were moderately strong. Thus the question how is it that it helps Mrs. M. to relax during her contractions? In what ways can you assist her in having a laid back experience?

 Importance of Relaxation:

 - Effective Labor Progression: In efficient uterine contractions, relaxation is essential; tension can only slow down the processes. When expecting women get stressed up, the perception of pain, and tension in muscles increases, which may even hamper labour.

 - Pain Management: Such techniques can decrease the rating of the pain and therefore help the mother to handle the contractions better.

 Methods to Promote Relaxation:

 - Breathing Techniques: Use slow, big breaths as a way of reducing pain and bringing about relaxation.

 - Comfort Measures: Apply comfort measures that may include positioning the infant in a comfortable position such as with their head supported as well as gentle massaging as well as using warm compress.

 - Emotional Support: Give her comfort and encouragement to calm her and make her to concentrate.

  4. At what time according to the opinion of the doctor shouldMrs. M. receive the ordered medication? Further measures that must be observed when so administering the medication are? What should be observed, after undertaking has been given? Why? The following would be the observations that I would report to the doctor of the patient:

 Timing for Medication:

 - Indication: Give the medication when Mrs. M is feeling uncomfortable and would greatly desire to find some comfort, not so close to the time when the baby is due for birth as this may have harms on the baby’s response.

 Safety Measures:

 - Assess Allergies and Contraindications: Ask Mrs. M. about her Demerol and Phenergan allergies and contraindication.

 - Monitor Vital Signs: It is recommended to take Mrs. M. ’s vital signs before taking the medication to make sure that she is fit enough for the treatment.

 - Administer as Prescribed: Give the respective medication at the correct frequency, timetable, route if prescribed:

 Post-Medication Observations:

 - Monitor for Side Effects: Assess for any side effects associated with the medication including; drowsiness, dizziness, or nausea on Mrs. M.

 - Fetal Monitoring: The maternal medication should also be observed in relation to fetal heart tones so as to ascertain that the fetus is favored and in good response to the medication.

 - Labor Progress: Monitor the advancement in labor and comfort of Mrs. M.

 Observations to Report:

 - Inform any alterations in the client’s vital signs, fetal heart rates, or any side effects to the administration of the medicine.

  5. How would you appreciate that Mrs. M. is in the transition phase?

 Indicators of Transition Phase:

 - Contraction Pattern: During transition contractions are reported to be very intense, and occur more frequently, every 2-3 minutes, and they also tend to be longer, 60-90 seconds.

 - Cervical Dilation: Mrs. M. would be 8-10 cm dilated at this time. It is sudden and involves dilation from 7 to 10 cms.

 - Behavioral Signs: Mrs. M. may present: musculoskeletal discomfort, increased anxiety and/or irritability, nausea or vomiting. She might also experience the desire to bear down.

 - Physical Symptoms: In some moments, it may be observed that rectal pressure has raised and they have immature pushing desires.

  6. On a vaginal examination Mrs M is fully dilated at 10 cm and at plus 2 station. The following are the appropriate nursing interventions that should be developed at this time:

 Nursing Interventions:

 - Prepare for Delivery: Prepare all equipment for delivery and make certain that all things needed for the childbirth are prepared and positioned.

 - Support and Coaching: Encourage and counsel Mrs. M. as she enters the pushing stage. Give her an advice or show her some instances on how to use the proper techniques for pushing.

 - Monitor Fetal Heart Tones: Keep on observing the fetal heart tones so as to be certain that the baby is doing well when it comes to the pushing stage.

 - Assist with Positioning: Support Mrs. M. to achieve comfort in the position used during labor and delivery.

 - Communicate with the Healthcare Team: Inform the doctor and other members of the team that Mrs. M. is ready to deliver and prepare for the same.

 Through these interventions, you will assist Mrs. M. to progress through the stage of labor for the last phase to promote the safe delivery and close monitoring of both the mother and the new born baby.