SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

Nursing Department

SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)

Name: Cumayas, Divine Grace N. Group: _____ Date: 03/17/2021

A. Define the following:

1. Amniotic fluid embolism

- is a rare but serious condition that occurs when amniotic fluid — the fluid that
surrounds a baby in the uterus during pregnancy — or fetal material, such as
fetal cells, enters the mother's bloodstream.

2. Battledore placenta
- is a condition in which the umbilical cord is inserted at or near the placental
margin rather than in the center.

3. Cephalopelvic disproportion
- occurs when a baby's head or body is too large to fit through the mother's pelvis.

4. Hypertonic uterine contraction

- is a potential complication of labor induction. It is defined as either a series of
single contractions lasting 2 minutes or more or a contraction frequency of five or
more in 10 minutes.

5. Umbilical cord prolapse

- is when the umbilical cord comes out of the uterus with or before the presenting
part of the baby. The concern with cord prolapse is that pressure on the cord
from the baby will compromise blood flow to the baby.

6. Placenta accrete
- is a serious pregnancy condition that occurs when the placenta grows too deeply
into the uterine wall.
7. Placenta circumvallate
- is a placental morphological abnormality, a subtype of placenta extrachorialis in
which the fetal membranes (chorion and amnion) "double back" on the fetal side
around the edge of the placenta.

8. Dystocia
- encompasses a variety of concepts, ranging from "abnormally" slow dilation of
the cervix or descent of the fetus during active labor3 to entrapment of the fetal
shoulders after delivery of the head.

9. Uterine inversion
- is when the uterus turns inside out, usually following childbirth.

10. Augmentation of labor

- is the process of stimulating the uterus to increase the frequency, duration and
intensity of contractions after the onset of spontaneous labour.

B. Explain the following dysfunction in the first and second stage of labor.

1. Prolonged deceleration phase

When there is a prolonged deceleration phase, progress in dilation slows after
8 cm and uterine contractions become dysfunctional, even after oxytocin
administration. In this situation, the cervix starts to swell and take on fluid. In this
situation, a C-section may be needed.

2. Arrest of descent
In an “arrest of descent”, the head of the fetus is in the same place in the
birth canal during the first and second examinations, which your doctor performs one
hour apart. This signifies that the baby hasn't moved farther down the birth canal
within the last hour.

3. Failure to descent
Cephalopelvic disproportion (CPD) is when your baby's head or body part is
too large to fit through your pelvis or birth canal during labor. It has also been
referred to as a "failure to progress" or "failure to descend" during labor.

4. Prolonged latent phase

If it lasts longer than: 20 hours in a woman having her first baby, or. More
than 14 hours in women who have already had a baby in the past.

5. Protracted active phase

 Protracted labor is abnormally slow cervical dilation or fetal descent during
active labor. Diagnosis is clinical. Treatment is with oxytocin, operative vaginal
delivery, or cesarean delivery. Active labor usually occurs after the cervix dilates to
≥ 4 cm.

C. Case Study

Mrs. Lim, age 36, is in premature labor, expecting twins. She is at 36 weeks’ gestation, and
one of the twins is a breech presentation. This is Mrs. Lim’s second multiple birth. Her
previous delivery of twins resulted in the death of twin A; twin B survived and was later
diagnosed with cerebral palsy.

1. What concerns might Mr. and Mrs. Lim voice about the impending cesarean birth?

Mr. and Mrs. Lim may voice out having anxiety since the first or previous
delivery of twins resulted in death of Twin A and Cerebral Palsy for Twin A. This is
her second multiple birth.

2. How would you prepare to respond to their questions and their anxiety?

Preoperative teaching is aimed at acquainting a woman with cesarean

procedure and any special equipment to be used, to make her as informed as
possible. Activities that help maintain respiratory and skeletal muscle function, to
prevent postsurgical complications, should also be included in teaching. Assess how
much the woman already knows about the surgery. Answer all specific questions,
and fill in gaps in knowledge. Ensure that all information offered are accurate. Be
certain not to use hospital jargon such as “NPO”.

3. While preparing Mrs. Lim for the cesarean birth, what changes and vital signs might
you assess that would indicate the development of additional problems or
complications for Mrs. Price?

Extensive blood loss can lead to hypovolemia and lowered blood pressure
since vessels are cut for surgery. So, it is essential to always monitor blood pressure
of the patient. As well as Respiration and heart rate are important indicators for any
complications.

4. Explain why Mrs. Lim is at risk for an alteration in fluid and electrolyte balance.
 A woman who enters surgery with a lower-than-normal blood volume will feel
the effect of surgical blood loss. A woman who began labor and later was told she is
to have a Cesarean Birth may have electrolyte imbalance, because she may have
had nothing to eat or drink for almost 24 hrs. Recent vomiting, diarrhea, or a chronic
poor fluid intake can compound her risk.