Danielle

Client profile Danielle, is a 41-year-old, G1P0,MWF, who has experienced a normal pregnancy. She is five feet three inches tall and her current weight is 148 pounds. Danielle works as a bartender and due to the long hours on her feet she has experienced +2 pitting edema in both ankles. The swelling goes down when she lies down. Last week she told the nurse that she felt foolish because she had had a crazy dream where She thought she was giving birth to a litter of puppies. Afterwards she sighed and said ”I’m much too old for this kind of thing”

Case Study Danielle arrived at the hospital on Friday afternoon complaining of intermittent to mild –moderate contractions for the past 12 hours. She denied ruptured membranes and bleeding. She is 39 weeks gestation. In the triage exam she was found to be 60%effaced, 1 cm dilated, and -3 station.

Case Study Her membranes were intact. Her contractions were 5-6 minutes apart, lasting one minute, and strong at the peak. The Obstetrician decided to admit her to labor and delivery suite and to artificially rupture her membranes (AROM) and begin Pitocin to augment her labor. Seven hours later after her admission she was diagnosed with failure to progress (FTP). She had dilated to 2cms and 100% effaced -3 station after 6 hours of Pitocin augmented labor and an epidural.

Case study She was given internal fetal monitoring/ internal uterine monitoring, which indicated a fetal heart rate baseline of 120 to 126 beats per minute with occasional accelerations for the first two hours. For the last hour of labor she had a baseline of 140-142 and an increasing number of variable decelerations. These decelerations were stopped when placed on her right side. She was given a cesarean section. Her baby girl weighed 8 pounds and was 21 inches long. Her APGARS were 8/8 with points off for tone and color.

Questions Is there any significance to the fact she was 41 years old? Is there any significance to the fact that this is her first pregnancy? Discuss Danielle’s dream.

Questions What is the significance of the 2+ pitting edema in her ankles? What are the advantages or disadvantages of cesarean section following labor as opposed to a scheduled section? List the indication and risk factors of artificial rupture of membranes. (AROM)

Questions Why do you think a cesarean was done? What is the difference between Pitocin induction and Pitocin augmentation? Analyze the information given regarding the fetal heart tones.

Questions 10. Why did the variable decelerations stop after the client was positioned on her right side? What other positions might have been used? 11. What effect might having an epidural have had on this labor and the cesarean section outcome? 12. What else might have been done to help the baby descend and labor progress?