Nursing Case Study for Maternal Newborn
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Outline
Luisa, 25 years old, is a 37-week pregnant patient who presents to triage with abdominal and back pain. She says she thinks she is in labor because her contractions are regular and about 10 minutes apart. Her electronic health record indicates she is G3 P1 A1 and she is followed by a local obstetrics and gynecology office. She states she thinks she may be in labor but “has not seen any fluid.”
What does G3P1A1 mean in regard to this patient?
What does the triage nurse understand labor to be in a pregnant woman?
Vital signs are as follows:
BP 150/94 mmHg SpO2 98% on room air
HR 91 bpm and regular Pain 2/10 at rest, 8/10 when she reports a contraction
RR 12 bpm at rest, 24 bpm when she reports what she thinks is a contraction
Temp 36.8°C
Which vital sign is most concerning to the nurse? What should they do regarding this vital sign?
The nurse decides to take the patient’s blood pressure manually which gives a reading of 130/82. Therefore, the patient is admitted to the labor and delivery unit.
SBAR report is given and Luisa’s admission for labor is started. She is placed in a convertible birthing bed with a fetal monitor attached to her abdomen.
What is the monitor called? What is it for?
Luisa progresses through an uneventful labor with her significant other at the bedside. She does not want any pain control and eventually delivers her newborn son, to be named after his father, Santiago.
At the time of birth, how would staff evaluate Santiago?
They determine Santiago is healthy enough to be placed on his mother’s chest to promote bonding and encourage breastfeeding. The staff takes him from his mother after a few minutes and she asks why.
What are staff doing when they remove Santiago at 5 minutes old?
Santiago weighs 3550 grams and is 50.6 cm long. Luisa and Santiago, Sr. ask what that is in pounds and inches so they can tell family and post on social media.
How does the staff respond to this?
Luisa and Santiago (referred to as a “mother-baby couplet”) are moved from the labor & delivery unit to the postpartum care unit as per protocol. The staff takes the newborn to the nursery for an evaluation. Luisa wants to know what they are looking for and if her son is healthy.
How should the nurse respond?
While the infant is being evaluated in the nursery, postpartum staff come in and assess Luisa. She wants to know why they keep feeling her abdomen and asking her about bleeding. She says, “I thought everything went OK. Why are you always checking on me?”
What is the best answer for Luisa?
The mother-baby couplet is set to be discharged home after a few days. It turns out that Luisa has no living children as her first pregnancy ended in stillbirth and her second was a miscarriage. She holds Santiago and is tearful as staff prepares to educate her for going home. She says, “I am so afraid I will hurt him or not do stuff right. Why do I keep crying? This is overwhelming.”
Should the nurse address this? What may help the transition from a postpartum unit to home?
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Transcript
Hi everyone. My name is Abby. We’re going to go through a case study together about maternal newborn. Let’s get started. In this scenario, our patient is Luisa. She’s 25 years old and 37 weeks pregnant. She presents to triage with abdominal and back pain. She says she thinks she’s in labor because her contractions are regular and about 10 minutes apart. Her electronic health record indicates that she is G3 P1 A1 and she is followed by a local obstetrics and gynecology office. She states she thinks she may be in labor, but has not seen any fluid. Let’s take a quick recap of what these numbers and letters mean. You may remember from a unit about maternal newborn, there is an acronym “GTPAL.” The G is Gravida that indicates the number of times a patient has been pregnant. T is for term deliveries and those births that are carried to term. P is preterm deliveries. A is abortions or miscarriages, and L refers to the number of live births. Now that you have this reminder, let’s take a look at our critical thinking checks below. They are number one and number two.
Great job. Let’s take a look at her vital signs. Her blood pressure came in just a little elevated at 150/94mmHg, her heart rate is 91 beats per minute with a regular rhythm and her respiratory rate of 12 when she’s at rest and 24 when she reports she’s having a contraction. Temperature looks good at 36.8 degrees Celsius and she’s saturating well on room air at 98%. In regards to pain, she reports she’s a 2 out of 10 when at rest, but of course that increases during a contraction to being more of an 8 out of 10. Now that we have some more information, let’s go ahead and take a look at our critical thinking check number three down below.
Well done. The nurse decides to take the patient’s blood pressure manually, which now gives us a new reading of 130/82 mmHg. Therefore, the patient is admitted to the labor and delivery unit. After an SBAR report, Luisa’s admission for labor is started. She’s placed into a convertible birthing bed and has a fetal monitor attached to her abdomen. Now that we have all this information, let’s take a look at our critical thinking check number four.
Great work. Luisa progresses through an uneventful labor with her significant other at the bedside. She doesn’t want any pain control and eventually delivers a newborn son to be named after his father, Santiago. Let’s take a look at critical thinking check number five and go through the rest of our scenario.
Well done. They determine that Santiago is healthy enough to be placed on his mother’s chest to promote bonding and encourage breastfeeding. We call this skin to skin. The staff takes him from his mother after a few minutes and she asks why. Now, what do you think? Why would they do that? Let’s take a look at critical thinking check number six below and see what we find out.
Wonderful. Santiago weighs 3,550 grams. He also is coming in at 50.6 centimeters long. Luisa and Santiago senior asks what that is in pounds and inches. They want to be able to post on social media for their friends and family. For reference, Santiago was 7.83 pounds and 19.2 inches. Now that we have that information, let’s go ahead and take a look at our critical thinking check below, starting with number seven.
Luisa and Santiago (referred to as a “mother-baby couplet”) are moved from the labor delivery unit to the postpartum care unit. As per protocol. The staff takes the newborn to the nursery for an evaluation. Luisa wants to know what they’re looking for and if her son is healthy. Have you been there yet in clinicals? Let’s take a look at our critical thinking check number eight and see what we find.
Wonderful job. While the infant is being evaluated in the nursery, postpartum staff come in and assess Luisa. She wants to know why they keep feeling her abdomen and asking her about bleeding? She says, “I thought everything went okay. Why do you keep checking on me?” Those nurses? We know why they’re checking on her. Let’s take a look at our critical thinking check number nine.
Wonderful work. The mother-baby couplet is set to discharge home after just a few days. Now let’s take a look back at our GTPAL values. Luisa has no living children as her first pregnancy ended in a stillbirth and her second was a miscarriage. So, as stated in our scenario, she’s a Gravida of G3 P1 A1, so she’s been pregnant three times. She had one preterm delivery and has had one abortion or miscarriage. Her Gravida will change. Now that she’s had Santiago, she gets tearful and she looks at him and says, “I’m so afraid I will hurt him and not do stuff right. Why do I keep crying? This is overwhelming.” The staff continue with some education and she’s excited to go home. Now we can take a look at our critical thinking check number 10 below.
Fantastic job everyone. This wraps up our case study on maternal newborn. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you guys, now go out and be your best self today, and as always, happy nursing!
References:
from uptodate: Overview of the postpartum period: Normal physiology and routine maternal care
Author:Pamela Berens, MD updated Nov, 2021; Preeclampsia: Clinical features and diagnosis
Authors:Phyllis August, MD, MPHBaha M Sibai, MD, updated Dec, 2021; Labor: Overview of normal and abnormal progression
Authors:Robert M Ehsanipoor, MDAndrew J Satin, MD, FACOG, updated Oct, 2021; Assessment of the newborn infant
Author:Tiffany M McKee-Garrett, MD, updated Oct, 2021; Overview of the routine management of the healthy newborn infant
Author:Tiffany M McKee-Garrett, MD, updated Feb, 2021. Also, some information for this case study was gained from informal interviews with several nurses with experience in labor & delivery and/or postpartum units. When asked about FAQs, they provided some of the questions contained within this case study.
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Nursing Case Studies
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.
We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
