Toco and US monitors
Orders:
Mrs. R was admitted with labor induction orders that included special considerations for monitoring her blood glucose and dosing for an insulin drip if necessary.
Ordered:
Maintenance Fluids D5NS (maintenance fluids given: Lactated Ringers)
Monitor BG levels every hour for 4 hours, then after 4 readings below 100, switch to every 2 hours.
If BG level is 101 or above start an insulin drip according to protocol.
Because the patient is already dilated to 3 cm. her ob ordered pitocin as her induction medication She can have her epidural upon request. The patient is asked to leave a urine sample and given a hospital gown to wear. She is then asked to lay in the bed and TOCO and US monitors are applied to monitor the baby's heartbeat and contraction pattern. The patient is informed that most inductions take 24 hours from beginning to birth.
All new patients get an IV started with maintenance fluids of Lactated Ringers. We also draw at least 2 tubes of blood: a clot and armband in case of emergency and a CBC. The CBC is necessary in case the patient requests an epidural. Also, upon admission, all patients are consented for vaginal delivery, epidural, Hepatitis B vaccine for the baby, and circumcision if appropriate. If it becomes necessary then a cesarean delivery consent is obtained.
The patient's prenatal records are reviewed for GBS status and Mrs. R is GBS Negative so she does not need additional penicillin during delivery. The patient's obesity makes it difficult to monitor the contractions and fetal heartbeat and the monitors must be repositioned throughout the night.
Assessment
A physical assessment was performed by the nursing student:
The patient is awake and oriented x3. She is excited about the birth of her child and does not appear anxious or nervous. She is accompanied by her husband. They both understand that there is a possibility of a heart defect in their son. The patient's lungs are clear to auscultation and her breathing is regular and unlabored. Her heart rate is regular rate and rhythm. She states that her last bowel movement was earlier in the day and she has no issues with GI or urinary system. Her deep tendon reflexes are normal at +2 and she has +3 edema in both feet. The patient shows some characteristics of PCOS which may explain the length of time it took her to become pregnant. The patient's blood glucose was monitored every hour for 4 hours. The first reading was 100 then went down into the 80's for the next 3 readings. BG monitoring was switched to every 2 hours.
Mrs. R was admitted with labor induction orders that included special considerations for monitoring her blood glucose and dosing for an insulin drip if necessary.
Ordered:
Maintenance Fluids D5NS (maintenance fluids given: Lactated Ringers)
Monitor BG levels every hour for 4 hours, then after 4 readings below 100, switch to every 2 hours.
If BG level is 101 or above start an insulin drip according to protocol.
Because the patient is already dilated to 3 cm. her ob ordered pitocin as her induction medication She can have her epidural upon request. The patient is asked to leave a urine sample and given a hospital gown to wear. She is then asked to lay in the bed and TOCO and US monitors are applied to monitor the baby's heartbeat and contraction pattern. The patient is informed that most inductions take 24 hours from beginning to birth.
All new patients get an IV started with maintenance fluids of Lactated Ringers. We also draw at least 2 tubes of blood: a clot and armband in case of emergency and a CBC. The CBC is necessary in case the patient requests an epidural. Also, upon admission, all patients are consented for vaginal delivery, epidural, Hepatitis B vaccine for the baby, and circumcision if appropriate. If it becomes necessary then a cesarean delivery consent is obtained.
The patient's prenatal records are reviewed for GBS status and Mrs. R is GBS Negative so she does not need additional penicillin during delivery. The patient's obesity makes it difficult to monitor the contractions and fetal heartbeat and the monitors must be repositioned throughout the night.
Assessment
A physical assessment was performed by the nursing student:
The patient is awake and oriented x3. She is excited about the birth of her child and does not appear anxious or nervous. She is accompanied by her husband. They both understand that there is a possibility of a heart defect in their son. The patient's lungs are clear to auscultation and her breathing is regular and unlabored. Her heart rate is regular rate and rhythm. She states that her last bowel movement was earlier in the day and she has no issues with GI or urinary system. Her deep tendon reflexes are normal at +2 and she has +3 edema in both feet. The patient shows some characteristics of PCOS which may explain the length of time it took her to become pregnant. The patient's blood glucose was monitored every hour for 4 hours. The first reading was 100 then went down into the 80's for the next 3 readings. BG monitoring was switched to every 2 hours.