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As a labor and delivery nurse, this is your second shift caring for Mallory Polk. She is a 42-year-old, single. African American attomey whom you admitted yesterday at 32 weeks’ gestation with the diagnosis of preterm labor. She was treated with magnesium sulfate and betamethasone. Tonight, when you come on your shift at 7:00p.m., she remains on magnesium sulfate but is contracting regularly and at 3:20 a.m. has SROM for clear fluid. At 4:00a.m. her cervix is 5 cm 90%/+1. At this time, the magnesium sulfate is discontinued and normal spontaneous vaginal birth anticipated because of advanced preterm labor, Over the next hour Mallory is contracting every 2 to 3 minutes and coping well with uterine contractions, Her sister, Allison, is at the bedside providing labor support. The FHR baseline is 140s, with average variability, occasional accelerations, and no decelerations. At 5:15 a.m. Mallory feels the urge to have a bowel movement and you do an SVE. Her vaginal exam reveals that she is 10 cm/100%/+1. Who needs to be notified of your significant assessment findings? What would you report? Within 15 minutes of your report, her physician arrives, confirms your assessment that Mallory is completely dilated, and wants her to start pushing. You coach Mallory to begin pushing with her next contraction What are your priorities in nursing care for Mallory? Discuss the rationale for the priorities State nursing diagnosis, expected outcome, and interventions related to this problem. What would you anticipate as Mallory reaching needs? Over the next hour, Mallory’s contractions slow to every 7 minutes and she is open-glottis pushing and feels the urge to bear down with the peak of contractions. An SVE reveals descent of the fetal head is +2 station. You request the physician to come to the bedside to evaluate fetal descent. After her physician evaluates Mallory, she requests oxytocin augmentation to increase the frequency of her contractions. You initiate oxytocin augmentation at 1 mL/min per physician orders. Discuss the risk associated with oxytocin augmentation Outline nursing actions when caring for a patient with arocin augmentation What teaching would you include related to anytocin augmentation Within 30 minutes of starting the oxytocin, Mallory is having UCs every 1 to 2 minutes lasting 45 to 55 seconds, moderate to palpation with a relaxed uterus between contractions. The FHR baseline is 140s with variable decelerations to 90s for 40 seconds with UCs, and FHR variability is moderate. What are your priorities in nursing care? Discuss the rationale for the priorities and nursing actions What are your nursing actions based on your assessment State nursing diagnosis expected outcomes. Over the next hour, Mallory’s contractions are every 3 to 4 minutes and she is pushing with contractions and has a strong urge to bear down with contractions. The FHR is 140s with moderate variability and variable decelerations to 100 bpm for 30 seconds with contractions and open-glottis pushing Her SVE reveals fetal descent to +3 station. What are your immediate priorities in nursing care for Mallory? Discuss the rationale for the priorities
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