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

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

It is likely to decrease second degree tears amongst primiparous females with the use of a multilayered midwifery involvement deprived of cumulative the occurrence of episiotomy. Additionally, the involvement is conceivable to service in superior maternity regions with midwives caring for females with together low and high hazard pregnancies.

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

a.Delayed pushing

The mainstream of women withstand some custom of perineal trauma through childbirth and primiparous women are more probable to agonize from severe wounds and second‐degree tears.

b.Positioning for pushing

Injuries moving the anal sphincter are occasionally incorrectly confidential as second grade tears and consequently not identified and sutured properly.

c.Spontaneous versus directed pushing efforts

A sluggish and measured natal of the baby is supposed to be of position to stop perineal trauma and midwives custom dissimilar methods to get the same. It has been imagined that impulsive pushing will decrease perineal trauma, but as of hitherto there is no indication for this.

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

Birth positions are frequently clear as moreover standing or supine. Otherwise they can be well-defined as supple sacrum positions where mass is unavailable off the sacrum, thus letting the pelvic opening to expand.

Does the evidence objectively support your argument (conclusion)?

Its influence be optional that a mixture of methods rather than one solitary method would be operative in stopping perineal wounds. Previously, dissimilar midwifery approaches such as impulsive assertive, birth locations, and other defensive methods have been assessed in dissimilar education weapons but not in multi-layered interferences mixing several approaches.

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

The management of the second stage of labor be subject to on the supplementary midwife's knowledge, information, and predilections. The supposition resulting from studying investigation and scientific involvement is that normal care for primiparous females covers typically of absorbed assertive and semi‐reclining birth situations. Additionally, midwives often favor to contribution the lady to natal the baby's head and shoulders in one contraction since of anxiety of risking the child.