Question

An 18 year old Primigravida presents to Labor And Delivery with what appears to be active labor. Upon questioning, you discover she has received no prenatal care. In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for stress, and denies any support system. The Father of the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins - they were too hard to swallow. She has no idea when her LMP was and she relates always being very irregular. * remember LMP is to ask the first day of the Last Menstrual cycle, not when the bleeding stopped* Objective information: Fetal heart tones are 130, with minimal variability Vaginal examination is 4 cm/90%effaced/ -1 station She is complaining of pain - 8/10 on a numerical scale. An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm. How can you provide non pharmacological comfort to this patient? What are the pharmacological methods to use? Without prenatal records or history GBS is unknown. What must you provide? Contractions are 5 minutes apart and you receive an order to augment labor - what non-pharmacological methods can you employ (or ask the MD to provide?) Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?

Answer 1

The non pharmacological ways to comfort the patient are

• Provide positive reassurance and psychological support to gain confidence and hope
• Appropriate positioning of the patient
• Mild back massage to ease the patient
• Cool compress
• Encourage the patient to void as this can relieve bladder pressure on the uterus

The pharmacological comfort to comfort the patient are

• Initiation of intravenous fluids
• Analgesics as per order to relieve pain under strict monitoring

Without prenatal records the following things is a must to be done

• Administration of TT as per order
• Carrying out blood investigation on the patient
• Continuous fetal heart rate monitoring

The non pharmacological approach during contraction are encouraging the client to ambulate to progress the labor, hydration therapy to relieve pain,etc.,

Pitocin has to be started generally at a rate of 0.5 -1mu per minute .It can be adjusted or titrated once in every half an hour or one hour.

An IV stand equipment is needed to hang and run pitocin.