Essentials of Maternity, Newborn, and Women’s Health Nursing

Chapter 11: Maternal Adaptation During Pregnancy

1. Jessica and Mike are new clients at your obstetrics office. You are asking them about the reason for their visit. Jessica says she thinks she is pregnant because she missed a period. Mike tells you Jessica is always nauseated in the morning and eats all the time the rest of the day. They have not been using birth control and have wanted to have children since they got married last summer. Jessica says her clothes are feeling tighter and her breasts seem tender. Mike says he has noticed that Jessica has been frequently getting up to go to the bathroom at night. (Learning Objectives 2 and 4)                   

1. What subjective symptoms have led Jessica and Mike to presume she is pregnant? What other conditions could be the cause of Jessica’s symptoms? How can a pregnancy be confirmed as probable? Diagnosed as positive?
2. Discuss the nutritional needs of Jessica and her baby.

2. Beth (age 18) is experiencing her first pregnancy and is now 24 weeks gestation. She tells you that she is “amazed by the changes that have happened to my body already.” Beth wants to understand what additional changes are going to occur to her “besides just getting a really huge belly.” Additionally, Beth relates to you that she is in her senior year of high school, is no longer involved with the baby’s father, and lives at home with her mother and 12-year-old brother. (Learning Objectives 3 and 5)

1. Explain to Beth (in terms she can understand) what general body adaptations she will experience throughout the remainder of her pregnancy.
2. What psychosocial adaptations may Beth experience as a result of being a teenage, single mother living at home?

Essentials of Maternity, Newborn, and Women’s Health Nursing

Chapter 13: Labor and Birth Process

1. Emily, age 32, has an obstetrical history of G1, T0, P0, A0, L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.

The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.

Ten minutes after the vaginal exam by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)

1. What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?
2. Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? Why?
3. Describe the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants.”

2. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)

1. Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.
2. What strategies may the nurse implement to assist Diane in progressing in her labor?