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In the Mississippi example, the nurse offered proper nursing interventions for the client and the infant. The nurse quickly started a fetal heart monitor and performed a vaginal exam, which revealed no cervical dilation. Later that morning, the customer felt pain in her abdomen and promptly called the doctor. The nurse continued to page the doctor despite not receiving any heart tones. The nurse noted all of the facts in the chart and did everything she could to help the client as a nurse. The nurse assessed, communicated and documented in the proper order to avoid neglect. Documentation in the patient’s record is used to detail care and interventions chronologically (RE, 2022).
In the Texas case, the nurse used inappropriate interventions on the client and the infant. The labor and delivery nurse’s job is to keep track of fetal heart tones and maternal contraction patterns. After studying the case, I saw long periods with alarming heart rates. The physician was never informed of the unsettling fetal heart tracings, and the nurse maintained the Pitocin while knowing there were unsettling heart tracings. When supervising the care of patients undergoing complex labor and birth, the nurse is expected to act in various capacities (NE, 2022).
A labor and delivery nurse must be able to make sound vital decisions. The nurse should have discontinued the Pitocin immediately and called the doctor in this scenario. There are measures in place to prevent errors and injuries. These include teams working together to be trained (physicians, midwives, nurses participating in fetal monitoring), and communication is ongoing, valued, and highly rewarded.
In the Texas case, it was apparent that there were steps that were missed. The nurse did not notify the provider when there was no proper reading of the fetal heart from the monitors. In the family’s nursing expert’s review of the situation, the nurse ensures that the equipment is working and recording the mother’s contraction. However, if it is not appropriately monitored, and we are unable to intervene early enough, the child will face long life disabilities (Schub, 2018). Per the pediatric neurologist, the fetus had “asphyxia consistent with bradycardiac events prior to her delivery.” These are things the labor and delivery nurse would have seen on the fetal heart monitor to see that there was a change in the positioning of the baby or the distress it may have been in due to the umbilical cord being around the fetus’ neck (Schub, 2018).
In the Mississippi case, the nurses worked together as a team to support the client. One nurse contacted the provider while the other monitored the pregnant client. The provider came to the situation promptly. Although, there was no need for continuous fetal heart monitoring due to the client not being in active labor, and the provider had known them from previous encounters (Arnold & Gawry, 2020). They continue to monitor the client’s blood sugar and provide insulin as needed. The nurse notices the change in the client’s pain and document every step of the way to ensure best practices.
Arnold, J. J., & Gawrys, B. L. (2020). Intrapartum Fetal Monitoring. American Family Physician, 102(3), 158–167.
Schub, E. R. B. (2018). Electronic Fetal Monitoring, External: Performing. CINAHL Nursing Guide.
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