Patient's Profile: A 22-year-old woman in her 2 pregnancy has arrived in the labor ward at 38 weeks 3 days She had a normal delivery 18 months ago. This pregnancy has been complicated by persistent vomiting until 20 weeks and more recently by anemia. She reports contractions commencing approximately 4 hours ago. She took paracetamol at home and tried to relieve the pain with a bath, but now she feels she cannot cope with the pain She had a show 2 days ago but has had no bleeding since then and has not noticed any vaginal leak. She has felt the baby moving normally all day. Physical Examination: BP is 110/58 mmHg, heart rate is 98/min. The presentation is cephalic with 2/5 palpable abdominally, Uterine contractions are palpable and the uterus is non-irritable. On vaginal examination the cervix is 5 cm dilated and the head is 1 cm above the ischial spines. The fetus is right occipitotransverse with mild caput and molding. The membranes are intact but rupture spontaneously during examination with clear liquor draining The woman requests for epidural for pain relief and is therefore on continuous cardiotocograph (CTG) monitoring, After 20 minutes you are asked to review the situation. The CTG as you walk in has the following interpretation! The initial 15 minutes of CTG shows a baseline of 145 min with normal variability (12/min) and no visible acceleration or decelerations. Following this, there is a drop-in fetal heart rate of 70/min for 7 minutes before gradual recovery to 125/min Contractions are 2 in 10 until the cardiotocograph becomes unreadable. Please answer all questions: 1. How do you explain the CTG interpretation? What are the possible causes of this interpretation of CTG? 3. What nursing/medical/surgical management would be appropriate now? Expound? 4. Using the nursing process, identify one priority nursing diagnoses for Mrs. Castro. Be sure to include related to and "as evidenced by statement.
Patient's Profile: A 22-year-old woman in her 2 pregnancy has arrived in the labor ward at 38 weeks 3 days She had a normal delivery 18 months ago. This pregnancy has been complicated by persistent vomiting until 20 weeks and more recently by anemia. She reports contractions commencing approximately 4 hours ago. She took paracetamol at home and tried to relieve the pain with a bath, but now she feels she cannot cope with the pain She had a show 2 days ago but has had no bleeding since then and has not noticed any vaginal leak. She has felt the baby moving normally all day.
Physical Examination: BP is 110/58 mmHg, heart rate is 98/min. The presentation is cephalic with 2/5 palpable abdominally, Uterine contractions are palpable and the uterus is non-irritable. On vaginal examination the cervix is 5 cm dilated and the head is 1 cm above the ischial spines. The fetus is right occipitotransverse with mild caput and molding. The membranes are intact but rupture spontaneously during examination with clear liquor draining The woman requests for epidural for pain relief and is therefore on continuous cardiotocograph (CTG) monitoring, After 20 minutes you are asked to review the situation. The CTG as you walk in has the following interpretation! The initial 15 minutes of CTG shows a baseline of 145 min with normal variability (12/min) and no visible acceleration or decelerations. Following this, there is a drop-in fetal heart rate of 70/min for 7 minutes before gradual recovery to 125/min Contractions are 2 in 10 until the cardiotocograph becomes unreadable.
Please answer all questions:
1. How do you explain the CTG interpretation? What are the possible causes of this interpretation of CTG?
3. What nursing/medical/surgical management would be appropriate now? Expound?
4. Using the nursing process, identify one priority nursing diagnoses for Mrs. Castro. Be sure to include related to and "as evidenced by statement.
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