Question

Case Study

Laurie is a 32-year-old primigravida at 40 weeks of gestation who is admitted to the Labor and Delivery unit in early labor. She has no know risk factors. Her bag of waters is intact, and she is 3 cm dilated, 90% effaced, and -1 station. The fetal heart rate is 120 with moderate variability, and she is contracting 3 to 4 minutes apart for 60 seconds.

As a woman progresses through the stages of labor, various body system adaptations will occur.

Questions:

1. What are the cardiovascular physiologic changes that occur during labor?

2. What position is beneficial for the laboring woman owing to these cardiovascular changes?

3. What are the respiratory physiologic changes that occur during labor?

4. Laurie asks the nurse if she can eat the turkey sandwich that her husband brought for her in the cafeteria. Should Laurie eat a sandwich while in labor? What are the gastrointestinal physiologic changes that occur during labor?

5. Laurie's labor progresses. her bag of waters ruptures spontaneously for clear fluid. She is 5 cm dilated on examination. Laurie wants an epidural for pain management. She is preloaded with IV fluid. her bladder is distended 1 hour after the epidural is placed, and the nurse obtains an order from the physician for an in and out catheterization. The nurse dipsticks Lauries urine for protein and it is 1+. Should the nurse be concerned about this finding?

6. Laurie is now 10 cm dilated and +2 station, and she feels the urge to push. What instructions should the nurse give Laurie about pushing?

Answer 1

1. Mostly cardiovascular changes that occurs during labor include cardiac output, increased blood volume, decreased arterial blood pressure.

2.The best position for lady is left lateral recumbent position.That is lying on her left side.

3.Oxygen demand increases during labor, there is 40-50% increase in minute ventilation. Uterus exerts pressure on diaphragm,decreases volume of inspiration and causes dyspnea.

4. Yes, she can eat sandwich. Gastric emptying time is slower during labor ,hence gastric volume increases.Analgesic drugs will further increase the gastric emptying time . The enlarged gravid uterus divides stomach into fundal and antral parts and increases gastric pressure.

6.Nurse should advice her to push, and don't hold her breath and don't count the length of push.