Week 5
Simulation Lab Activities - Jo Barrett
General History
Jo Barrett and her partner Peter are expecting their first baby. Jo is 28 years old and Peter is 31years. The pregnancy was mostly uneventful and all test results came back normal.
On the evening of the 5th September at 17.30 Jo noticed that irregular contractions are occurring. She was 40+4 weeks. Jo and Peter are very excited. Jo was coping well with the contractions so she decided to stay at home until the contractions are regular. They carry on their normal activities such as eating dinner, having an evening stroll and taking a long bath, and going to bed.
Jo woke at 2 am to a vaginal gush of water. She woke Peter and while Peter was phoning the hospital Jo put a pad on and got ready for the move to hospital. They arrived at the hospital at 2.30 and we seen by the midwife. On admission the Midwife assesses Jo’s progress in labour.
The Midwife took Jo’s vital signs (T 36.8, P 72bpm, BP 110/70), listened to the fetal heart (120 beats + regular & strong), performs a abdominal examination (cephalic presentation, LOP, 2/5 engaged), feels her contractions (2 - 3 mild to moderate contractions in 10 mins but irregular). The Midwife examined and tested the pad and agreed with Jo that her membranes had ruptured. A vaginal examination was done (cervix 2 – 3 cm, posterior, thick, not full effaced with the head above the spines). At 3.30 Jo called the Midwife as she was having trouble coping with the pain associated with the contractions and said she felt like pushing. The Midwife explained that the pushing pain was probably related to the position of the baby (LOP) pressing on her spinal nerves and not that she was ready to have her baby.
After a discussion about the types of pain relief available and given Jo was in the early stage of labour Jo and Peter decided they would have an epidural. The anaesthetist was paged and came to inserted the epidural. An IV cannula has been inserted. The anaesthetist put in the epidural with no problems, gives the test dose and connects Jo up the epidural infusion and starts the infusion.
Progression of labour is slow and the CTG was showing variable decelerations. At 0800 a scalp pH was performed (pH 7.18) revealing fetal distress. Jo was prepared for an emergency caesarean section. At 08.35 a healthy boy, Flynn was born. Flynn’s Apgar scores were 8 & 9 at 1 and 5 mins after the birth. Flynn and Jo have a few minutes together before Peter takes Flynn to the postnatal ward.
Tutorial Information
Your tutor will discuss the options of pain relief in labour including the use of an epidural. The video “The Colours of Caroline” will be shown.
Laboratory Activities:
* Infuse 500 mls IVI of a volume expander such as Hartmanns solution in IV and record on the FBC.
* Position Jo into a comfortable position and ensure she is not lying directly on her back
* Perform the routine 5 min observations of P, R, and BP for 20 mins. Chart your findings.
If there is a significant drop in BP (more than 10 – 15 mmHG diastolic) and an increase in P you need to regulate the IV fluids accordingly as to maintain her BP and prevent a hypoxic episode affecting Jo’s baby.
* Continue taking Jo’s observations until they have stabilized.
* Perform a urinary catheterization
* Undertake a postnatal assessment of a woman who has undergone a Lower Segment Caesarean Section
Take vital observations on Pat and check her colour, urine output via a catheter, wound dressing and vaginal discharge. You also need to check Pat has adequate pain relief. Pat’s vital signs need to be taken every 15 mins for the first 2 hours, then every 30 mins for the next 2 hours, then hourly due to the epidural morphine. (You need only take the first one)
* Apply TED thrombo embolitic deterrent stockings
* Assist Pat with the first breastfeed
* Complete your nursing documentation
