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Fatime Sanogo, induction of labor

Patient Introduction


Fatime Sanogo is a 23-year-old primiparous female from Mali in her first hour after vaginal delivery. The patient was admitted yesterday at 0600 hours for oxytocin induction of labor secondary to postdates (41 4/7 weeks). She declined all pain medication during labor…

Following a prolonged second stage, she delivered a vigorous female infant at 0605 hours with Apgar scores of 9 and 9 and weight of 4,082 g (9 lb 0 oz). The patient contracted a second-degree perineal laceration during delivery; this has been repaired.

Placenta was delivered manually at 0635 hours via Dr. Schultz. Bleeding was controlled by fundal massage and infusion of remaining oxytocin induction bag, which is still running at 20 mL/hr (20 mU/min); approximately 100 mL left in the bag.
The patient was just up to the bathroom and couldn’t void. She is now dozing, and the father of the baby is at the bedside, holding the baby and sending text messages from the phone. Fatime does not speak English fluently, as she has only been in the country for 7 months. You enter the room to assume care of the patient and to perform the second of four assessments every 15 minutes

Feedback Log
0:00 You arrived at the patient.
0:00 You introduced yourself.
0:05 You washed your hands. To maintain patient safety it is important to wash your hands as soon as you enter the room.
0:10 Patient status – Heart rate: 104. Pulse: Present. Blood pressure: 98/50 mmHg. Respiration: 18. Conscious state: Appropriate. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
0:24 You identified the patient. To maintain patient safety it is important that you quickly identify the patient.
0:35 You looked for normal breathing. She is breathing at 19 breaths per minute. The chest is moving equally.
1:03 You attached the <Pulseoximeter>pulse oximeter.<> This was indicated by order.
1:10 Patient status – Heart rate: 105. Pulse: Present. Blood pressure: 98/50 mmHg. Respiration: 19. Conscious state: Appropriate. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
1:15 You checked the radial pulse. The pulse is strong, 105 per minute and regular. It is correct to assess the patient’s vital signs.
1:42 You measured the <Bloodpressure>blood pressure<> at 98/50 mmHg. It is appropriate to monitor the patient by measuring the blood pressure.
2:08 You checked the <Temperature>temperature<> at the mouth. The temperature was 37 C.
2:10 Patient status – Heart rate: 107. Pulse: Present. Blood pressure: 99/51 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
2:29 You examined the patient’s skin. There is tenting sign of the skin. Her color is normal and she is not sweating.
2:40 You performed a tap and shout. The patient was responsive.
2:58 You assessed the patient’s neurological status. This is reasonable.
3:10 Patient status – Heart rate: 108. Pulse: Present. Blood pressure: 99/51 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 96%. Temp: 37 C. EFM: –. Fetal heart rate: –.
4:10 Patient status – Heart rate: 110. Pulse: Present. Blood pressure: 96/50 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 96%. Temp: 37 C. EFM: –. Fetal heart rate: –.
4:19 You checked the deep tendon reflexes. This was reasonable. The deep tendon reflexes were normal. Graded to +2.
4:37 You checked the patient’s pupils and they were 7 mm and reactive. It is reasonable to check the pupils here.
4:57 You checked the corneal reflex. The corneal reflex was present.
5:10 Patient status – Heart rate: 111. Pulse: Present. Blood pressure: 96/50 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 96%. Temp: 37 C. EFM: –. Fetal heart rate: –.
5:14 You checked the eyelash reflex. The eyelash reflex was present.
5:32 You checked the eye movements. There was normal range of motion.
5:50 You assessed the patient’s IV. The site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. This is correct. Assessing any IVs the patient has is always important.
6:09 You asked if the patient was <Allergy>allergic<> to anything. (In pain) She replied: ‘No, I am not allergic to anything.’
6:10 Patient status – Heart rate: 113. Pulse: Present. Blood pressure: 94/49 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 95%. Temp: 37 C. EFM: –. Fetal heart rate: –.
6:49 You administered 2 mg of butorphanol tartrate IV. It is important to use the basic rights of medication administration to ensure proper drug therapy. This was indicated by order.
6:59 You flushed the cannula.
7:10 Patient status – Heart rate: 114. Pulse: Present. Blood pressure: 96/51 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 95%. Temp: 37 C. EFM: –. Fetal heart rate: –.
7:31 You looked for normal breathing. She is breathing at 21 breaths per minute. The chest is moving equally.
8:06 You checked for blood, lochia, and fluid on the bed.
8:10 Patient status – Heart rate: 115. Pulse: Present. Blood pressure: 94/49 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 95%. Temp: 37 C. EFM: –. Fetal heart rate: –.
8:23 You changed and weighed the bed pads. The increase in weight of the bed pads suggests that approximately 1270 mL of lochia was on the pads. The time since the last change of the pads suggests a bleeding rate of approximately 1980 mL/hr.
8:56 You assisted the patient into Trendelenburg position.
9:10 Patient status – Heart rate: 117. Pulse: Present. Blood pressure: 93/49 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 95%. Temp: 37 C. EFM: –. Fetal heart rate: –.
9:31 You assessed the bladder status. The bladder contained 300 mL of urine.
9:49 You assessed the patient’s perineum. This was reasonable. There was minimal redness, minimal edema, no echimosis, and no discharge from the repair, and it is well approximated. A lot of blood and lochia was seen in the vaginal. She was bleeding at a moderate rate.
10:10 Patient status – Heart rate: 118. Pulse: Present. Blood pressure: 93/49 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 95%. Temp: 37 C. EFM: –. Fetal heart rate: –.
10:21 You palpated the fundus of uterus. This was reasonable. The uterus was soft and boggy.
10:44 You performed a straight catheterization. This was reasonable. The bladder was emptied. There was about 300 ml of urine in the bladder.
11:10 Patient status – Heart rate: 119. Pulse: Present. Blood pressure: 90/48 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 94%. Temp: 37 C. EFM: –. Fetal heart rate: –.
11:22 You performed fundal massage. This was indicated and the correct response to the patient’s condition. The uterus did not firm up properly.
11:47 You examined the patient’s head. There is no obvious airway obstruction. There is tenting sign of the skin. Her color is normal and she is not sweating.
12:02 You examined the patient’s arms. There is nothing to find on examination of the arms.
12:10 Patient status – Heart rate: 120. Pulse: Present. Blood pressure: 93/49 mmHg. Respiration: 21. Conscious state: Appropriate. SpO2: 94%. Temp: 37 C. EFM: –. Fetal heart rate: –.
12:11 You examined the patient’s abdomen and pelvis. There is nothing to find on examination of the abdomen and pelvis.
12:22 You examined the patient’s legs. There is nothing to find on examination of the legs. It’s appropriate to perform a physical head-to-toe examination.
12:42 You examined the patient’s skin. There is tenting sign of the skin. Her color is normal and she is not sweating.
13:01 You checked for edema. This was reasonable. There is no pitting edema.
13:10 Patient status – Heart rate: 122. Pulse: Present. Blood pressure: 93/50 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 94%. Temp: 37 C. EFM: –. Fetal heart rate: –.
13:25 You listened to the lungs of the patient. The breath sounds are clear and equal bilaterally.
13:50 You listened to the heart of the patient. There were regular heart sounds without murmurs.
14:10 Patient status – Heart rate: 123. Pulse: Present. Blood pressure: 92/50 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 94%. Temp: 37 C. EFM: –. Fetal heart rate: –.
14:16 You listened to the abdomen of the patient. Normal bowel sounds were heard.
14:22 You looked for normal breathing. She is breathing at 22 breaths per minute. The chest is moving equally.
14:48 You measured the <Bloodpressure>blood pressure<> at 92/50 mmHg.
15:10 Patient status – Heart rate: 124. Pulse: Present. Blood pressure: 89/48 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
15:14 You checked the <Temperature>temperature<> at the mouth. The temperature was 37 C.
15:40 You checked the radial pulse. The pulse is strong, 125 per minute and regular.
16:06 You checked the carotid pulse. The pulse is strong, 125 per minute and regular.
16:10 Patient status – Heart rate: 125. Pulse: Present. Blood pressure: 88/48 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
16:32 You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This will allow you to reassess the patient continuously.
16:58 You phoned the provider in order to discuss the patient.
17:10 Patient status – Heart rate: 126. Pulse: Present. Blood pressure: 88/48 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
18:10 Patient status – Heart rate: 127. Pulse: Present. Blood pressure: 89/49 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
18:20 You assisted the patient into sitting position.
19:10 Patient status – Heart rate: 129. Pulse: Present. Blood pressure: 86/47 mmHg. Respiration: 22. Conscious state: Appropriate. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
19:17 You verified the dose with another nurse. This was reasonable. The dose was correct.
19:40 Patient status – Heart rate: 129. Pulse: Weak. Blood pressure: 86/47 mmHg. Respiration: 22. Conscious state: Somnolent. SpO2: 93%. Temp: 37 C. EFM: –. Fetal heart rate: –.
20:06 Patient status – Heart rate: 129. Pulse: Present. Blood pressure: 86/47 mmHg. Respiration: 23. Conscious state: Appropriate. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
20:24 Patient status – Heart rate: 130. Pulse: Weak. Blood pressure: 86/47 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
20:24 You started infusing oxytocin postpartum (mL/hr) at 500 mL/hr. This was indicated by order.
20:35 Patient status – Heart rate: 130. Pulse: Present. Blood pressure: 85/47 mmHg. Respiration: 23. Conscious state: Appropriate. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
20:53 Patient status – Heart rate: 130. Pulse: Weak. Blood pressure: 85/47 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
21:08 Patient status – Heart rate: 130. Pulse: Present. Blood pressure: 86/47 mmHg. Respiration: 23. Conscious state: Appropriate. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
21:19 You started a bolus of 500 mL of lactated Ringer’s solution IV, given over 30 minutes. It is important to give IV fluids to bleeding patients.
21:37 Patient status – Heart rate: 131. Pulse: Weak. Blood pressure: 84/47 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 92%. Temp: 37 C. EFM: –. Fetal heart rate: –.
21:40 You assessed the patient’s IV. The site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. If you are in doubt, it is always a good idea to re-assess any IVs the patient has.
22:02 You gave the patient 100% oxygen from a nonrebreathing mask.
22:08 You turned the oxygen on.
22:37 Patient status – Heart rate: 130. Pulse: Weak. Blood pressure: 82/46 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 94%. Temp: 37 C. EFM: –. Fetal heart rate: –.
23:04 You performed a straight catheterization. This was indicated by order. There was no urine in the bladder.
23:24 You looked for normal breathing. She is breathing at 23 breaths per minute. The chest is moving equally.
23:37 Patient status – Heart rate: 127. Pulse: Weak. Blood pressure: 83/46 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
24:09 You tried to provide patient education. The patient was still under stress. This might not be the best time for patient education.
24:37 Patient status – Heart rate: 126. Pulse: Weak. Blood pressure: 82/45 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 98%. Temp: 37 C. EFM: –. Fetal heart rate: –.
25:25 You took a blood sample. This was not part of your orders here.
25:37 Patient status – Heart rate: 127. Pulse: Weak. Blood pressure: 81/45 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 99%. Temp: 37 C. EFM: –. Fetal heart rate: –.
25:44 You tried to verify the blood, but the patient didn’t have any orders for blood transfusion.
26:28 A 800-mcg dose of misoprostol was given rectally. This was not part of your orders.
26:37 Patient status – Heart rate: 127. Pulse: Weak. Blood pressure: 82/45 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 98%. Temp: 37 C. EFM: –. Fetal heart rate: –.
27:09 You verified the dose with another nurse. This was reasonable. There was no orders for this drug.
27:37 Patient status – Heart rate: 128. Pulse: Weak. Blood pressure: 80/44 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 98%. Temp: 37 C. EFM: –. Fetal heart rate: –.
28:37 Patient status – Heart rate: 128. Pulse: Weak. Blood pressure: 80/46 mmHg. Respiration: 23. Conscious state: Somnolent. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
28:40 You phoned the provider in order to discuss the patient.
You should administer morphine as ordered.
29:35 Patient status – Heart rate: 129. Pulse: Present. Blood pressure: 83/49 mmHg. Respiration: 23. Conscious state: Appropriate. SpO2: 97%. Temp: 37 C. EFM: –. Fetal heart rate: –.
29:41 You ended the scenario by returning to the nurse’s station. This was reasonable.

MS. SANOGO

  1. Document your initial assessment data for Ms. Sanogo, including vital signs, fundal assessment (consistency, position, location), lochia assessment (amount, color, odor, consistency), and pain (location, quality, severity).
  2. Write the situation-background-assessment-recommendation (SBAR) communications you would use to update the provider on Ms. Sanogo’s status after your first encounter with her.
  3. Document the medication(s) you administered to Ms. Sanogo and evaluate each drug’s effectiveness.
  4. Document the sequence of events during the simulation (i.e., vital signs, assessment findings, blood loss, nursing interventions, and patient response).
  5. Ms. Sanogo is going to be taken back to labor and delivery for a manual examination. Write the transfer note.
    Answer
    1 Document your initial assessment data for Ms. Sanogo, including vital signs, fundal assessment (consistency, position, location), lochia assessment (amount, color, odor, consistency), and pain (location, quality, severity).
    Vital signs: Heart rate: 111. Pulse: Present and strong. Blood pressure: 98/50 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 96%. Temp: 37·Fundal assessment: Soft and boggy, above the umbilicus, and deviated to the right· Lochia Assessment: Moderate – 1240 mL, lochia rubra, stale and musty odor, and consistency is epitheal cells, RBC, WBC, bacteria, shreds of decidua, fetal meconium, lanugo (baby hair), vernix caseosa, and small clots; Pain: Adominal area, severe, sharp, and sudden pain, and 5 on a scale of 0-10.
  6. Write the situation-background-assessment-recommendation (SBAR) communications you would use to update the provider on Ms. Sanogo’s status after your first encounter with her.
    Situation
    Fatime Sanogo, 23 years old female, admission diagnose: indrucition of labor secondary to postdates.
    Background
    She deliver a vigorous female infant at 0605 hours with apgar scores of 9, and weight of 4, 082g (91Ib 0oz). The patient contacted a second degree perineal laceration during the delivery’ this has been repaired.
    Assessment:
    Moderate – 1240 mL, lochia rubra, stale and musty odor, and consistency is epitheal cells, RBC, WBC, bacteria, shreds of decidua, fetal meconium, lanugo (baby hair), vernix caseosa, and small clots. -Pain: Abdomen, severe, sharp, sudden pain, 5 on a scale of 0-10.Vital signs: Heart rate: 111. Pulse: Present and strong. Blood pressure: 98/50 mmHg. Respiration: 20. Conscious state: Appropriate. SpO2: 96%. Temp: 37 -Fundal assessment: Soft and boggy, above the umbilicus, and deviated to the right. –Lochia.

    Recommendation
    Re-assess patient breathing, pain level, bleeding/ lochia, and the bladder.
  7. Document the medication(s) you administered to Ms. Sanogo and evaluate each drug’s effectiveness.
    -Butorphanol tartrate 2 mg. IV PRN for pain. Do not repeat.
    -Ibuprofen 800 mg Q8 hours not to exceed 2400 mg in 24 hours .
    -Lactated ringer 500mg IV bolus.
    -Oxytocin (Pitocin) 500mL
  8. Document the sequence of events during the simulation (i.e., vital signs, assessment findings, blood loss, nursing interventions, and patient response).
    First step- Doctor Evacuation of the retained tissue from the uterus
    -Then oxytocin is administered to help to maintain uterine contraction.
    -Blood loss of 800 ml in 25 minutes, pulse tachycardia and weak. Pain scale 5 out of 10
    -Due to the increase blood volume of pregnancy, vital signs, and urine output, don’t reflect bleeding until appropriately 1800 ml (60.9 oz) of blood has been lost. Therefore, early estimation of blood loss are based on observations or weighing pads to quantify blood loss.
  9. Ms. Sanogo is going to be taken back to labor and delivery for a manual examination. Write the transfer note.
    Ms. Sanogo is being transported to labor and delivery for manual examination. Monitor the patient for risk of hemorrhage.

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