Question

Part 1

Critical Thinking Case Study: Delayed Pushing in Second Stage Labor from text page 428:

A nurse is assigned to care for Emily, a 25-year-old G1 P0 at 39 weeks of gestation. The nurse has just performed a vaginal examination and found that Emily's cervix is completely dilated. She has an epidural, which is working well. Currently Emily is feeling neither pressure nor pain. On learning that Emily's cervix is completely dilated, her health care provider exclaims (not the nurse), “Good! Get in there and help her push so we can have this baby! I'm ready to go home. I've had a long day!” Provide EB rationale for all responses.

1.      Evidence—Is there sufficient evidence to draw conclusions about effective management of second-stage labor?

2.      Assumptions—Describe an underlying assumption about each of the following issues:

a.       Delayed pushing

b.      Positioning for pushing

c.       Spontaneous versus directed pushing efforts

3.      What implications and priorities for nursing care can be drawn at this time?

4.      Does the evidence objectively support your argument (conclusion)?

Part 2

  Question: Answer the following questions and provide rationale for the answer choice:

A primigravida is pushing with contractions. The nurse notes that the woman’s perineum is beginning to bulge and that there is an increase in bloody show. Which of the following actions be the nurse is appropriate at this time?   

a)      Report the findings to the patient’s health care practitioner

b)      Immediately assess the client’s pulse and blood pressure

c)      Provide encouragement during each contraction

d)      Place the client on her side with oxygen mask at 8 liters/min

Answer 1

Part 2 ANS: C. Provide encouragement during each contraction

Explanation: Because this is a normal finding, the nurse should continue to provide labor support and encouragement. The bulging perineum is an indication that the baby is descending in the birth canal and the bloody show results from injury to the capillaries in the mother's cervix. Because this woman is a primigravida, she will likely need to push for many more minutes so it is not neces- sary to notify the health care provider until additional signs are noted.