Maternity Case 5: Amelia Sung (Core)

Guided Reflection Questions

Opening Questions
How did the simulated experience of Amelia Sung’s case make you feel?

I felt exciting at first when I realized that this scenario included the patient delivering a baby. Although I
felt great about this scenario, I was frustrating at first. I did not know what to do when the physician
coming for the delivery. I spent lots of time to figure out what to do and how to encourage and calm the
patient at the same time. I redid it a few time until I was satisfied with my result.

Describe the actions you felt went well in this scenario.

After the first run-through, I had a fairly idea of what needed to be done. I monitored VS, assessed head-
to-toes assessment, checked breath sound, checked deep tendon reflexed, checked for edema based on
ordered. When physician came for the delivery, I know what to do to prepare for the delivery, calm and
educate the patient about her condition as well as continued to monitor for vital signs. Called charge
nurse about risk for shoulder dystocia.

Scenario Analysis Questions1

EBP/I Discuss why shoulder dystocia is an obstetrical emergency.

Shoulder dystocia is an emergency because it halts the delivery progress. The baby needs to
be manipulated to fit and pass under the pubic symphysis. There are both maternal and
fetal complications if the shoulder dystocia is not resolve quickly.

EBP Name one of the two distinct signs that indicate shoulder dystocia is present.

If there is shoulder dystocia, the baby may present with turtle sign. This means that after the
head is delivered, it gets pulled tight against mom. Another sign is the baby cheeks may puff
out due to the additional pressure.

EBP List potential problems for Amelia Sung and her baby related to the shoulder dystocia.

Mom complications: post-partum hemorrhage, cervical and/or vaginal lacerations,

lacerations of the rectum and/or bladder, femoral neuropathy.

1
The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP),
Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/

From vSim for Nursing | Maternity. © Wolters Kluwer Health.

 Baby complications: asphyxiation, pinched nerves, paralysis of arm, nerve damage, broken
clavicle, fractured arm, contusion.

PCC/T&C What preventive measures were put in place related to Amelia Sung’s history of a previous
shoulder dystocia?

The patient was placed into a lateral tilt position to help a baby align properly, also a step
stool was brought in close in case the provider needed to provide suprapubic pressure to
help increase the baby’s shoulder

S/QI/I Consider what points might be included in a safety checklist for shoulder dystocia.

Education might be the first things that come to mind. Mom needs to have a thorough
interview and the nurse needs to get a comprehensive history about any problem mom
encountered with previous deliveries. Mom should be educated about any positions that
can help encouraging the baby to get into the right alignment. The nurse needs to make
sure there is a step stool close by in case the provider needs to use suprapubic pressure.

Concluding Questions
Reflecting on Amelia Sung’s case, were there any actions you would do differently? Explain.

I typically redo the simulation multiple time until I get familiar with the scenario and a perfect score. I
did not call the charge nurse for the first-try and did not know about the bassinet as well as the step
stool. That’s what I learnt the important of bassinet and step stool for patient who at risk for shoulder
dystocia.

Describe how you would apply the knowledge and skills that you obtained in Amelia Sung’s case to an
actual patient care situation.

I have a deeper understanding about how urgent shoulder dystocia is, and what need to be done to get
it resolved as soon as possible. It will definitely help me if I get any experience witnessing this in the real
life practice.

From vSim for Nursing | Maternity. © Wolters Kluwer Health.