NCLEX question relating to L&D

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  1. This is a discussion on NCLEX question relating to L&D in Ob/Gyn Nursing, part of Nursing Specialties ... could you please help me with the order of this question? the order is different in every...

    by Aug 7, '12
    could you please help me with the order of this question? the order is different in every book
    thanks a lot from now on

    when evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (fhr) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. rank in order of priority the interventions the nurse should take (with 1 being the first action).
    drag and drop options into the correct order.
    change the woman's position
    administer iv fluid bolus
    provide oxygen y face mask
    discontinue oxytocin infusion
    notify primary health care provider
    document interventions
    Last edit by JustBeachyNurse on Aug 28, '12 : Reason: formatting
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    by ygmr6666 Aug 7, '12 12:57 pm
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  3. 18 Comments so far...

  4. Asst. Admin
    Aug 7, '12 by
    This post has been moved to a thread on its own in the OB/Gyn Nursing forum where it more properly belongs.
  5. Aug 7, '12 by
    That is tricky. Everything that I have read doesn't put one single action as the 'first' intervention, but I would go by what the NCLEX book says.

    Mine says to d/c the pit first.
  6. Aug 7, '12 by
    I would change her position, with turning off Pit being an immediate second step.
    sugarbee likes this.
  7. Aug 7, '12 by
    Quote from ygmr6666
    could you please help me with the order of this question? the order is different in every book
    thanks a lot from now on

    when evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (fhr) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. rank in order of priority the interventions the nurse should take (with 1 being the first action).
    drag and drop options into the correct order.
    change the woman's position
    administer iv fluid bolus
    provide oxygen y face mask
    discontinue oxytocin infusion
    notify primary health care provider
    document interventions
    turn pit off first, change position, provide oxygen, administer iv, notify provider, document

    the case could be made for other orders, though.
    Last edit by JustBeachyNurse on Aug 28, '12 : Reason: formatting
    sugarbee likes this.
  8. Aug 7, '12 by
    Depends--has the tracing been fine until this point? If so I would reposition, give IV fluid, oxygen, inform my provider and have them view the tracing and also (not mentioned) assess the strength and frequency of contractions. If the decels persisted and in consultation with the PCP I would turn off the pit. If they resolved you wouldn't have to and would avoid wasting time and lengthening labour by having to start your oxytocin from a lower level. That's based on the experiences I've had with turning off oxytocin before trying other things (for decelerations that are not deep or prolonged--for those decels pitocin off would be my first step for sure).
    sugarbee likes this.
  9. Aug 8, '12 by
    As Far as NCLEX goes I was always taught ABC's (Airway, Breathing, Circulation) ALWAYS. However, OB is quite different in real life. If I were to answer this on NCLEX I would choose turn pit off, o2 mask, change position, iv fluids, notify physician, document. The one thing about nclex is that its not true to real life situations so always answer the questions the way you think THEY would want you to answer them. Dont try to answer them the way that seems logical to you.lol
    sugarbee likes this.
  10. Aug 8, '12 by
    thank you for all of you by taking time to answer my question. in saunders order is : discontinue oxytocin, change woman position, provide oxygen, administer iv, notify physician and documentation. most of you gave similar to this order.

    the order in ncsbn learning extension is :
    change the woman's position
    administer iv fluid bolus
    provide oxygen y face mask
    discontinue oxytocin infusion
    notify primary health care provider
    document interventions

    i sent them an e-mail and they said the answer is assured by 10 years experienced ob nurse; however, i feel not comfortable and sent you guys the question. i guess i should follow what the saunders says. i appreciate your help...
    Last edit by JustBeachyNurse on Aug 28, '12
  11. Aug 12, '12 by
    Hello,Could you please give some clues or and formula that i can use for this question? Thanks a lot everone I don't know how to solve this question and never met before..QT interval: 0.52RR: 1.72 secondHow many second OTc interval (OT interval corrected for the heart rate)?
  12. Aug 12, '12 by
    Quote from ygmr6666
    Thank you for all of you by taking time to answer my question. In saunders order is : discontinue oxytocin, change woman position, provide oxygen, administer IV, notify physician and documentation. Most of you gave similar to this order.

    The order in NCSBN learning extension is :
    Change the woman's position
    Administer IV fluid bolus
    Provide oxygen y face mask
    Discontinue oxytocin infusion
    Notify primary health care provider
    Document interventions

    I sent them an e-mail and they said the answer is assured by 10 years experienced OB nurse; however, I feel not comfortable and sent you guys the question. I guess I should follow what the saunders says. I appreciate your help...
    Research uterine resecuitation. Think about in this way: least invasive intervention that could impact the patient the most. With NCLeX First answer is almost always turn off any medications that could be contributing to the problem. This is no different. Repositioning in labor is always going to be up there in priority because alot of problems with laboring patients involves attempting to move, perfuse, turn, alter babies position.

    Late decels deal with (in NCLeX world) with placenta not working great anymore... Baby needs help.

    Don't stress the baby anymore. (turn off pit-it is a stressor)
    Reposition. (see if it gets better-MAYBE baby laying in a bad position and not perusing well)
    Apply 02, for baby to give it any extra sat levels as possible
    IV bolus- increase perfusion opportunities to baby with more fluid on board through mom
    This is considered a "crisis" and all units should have a policy/standing orders in place to take these interventions-so you notify dr after all "fix" measures have been taken. Kind of like "baby CPR".
    Document always comes last. Patient care first.
    ygmr6666 likes this.