Case Study Presentation: On Fetal Distress

University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES
COLLEGE OF NURSING
2ND SEMESTER, AY 2021-2022
BACHELOR OF SCIENCE IN NURSING – LEVEL IV
CASE STUDY
PRESENTATION
ON FETAL DISTRESS
Lim, Cielo Rose

Betana, Kristel
Castillo, Juren
Trilles, Rochelle
Romias, Jhoanna Marie
Decena, Angelo
Tuluan, Prince
BSN 4 Group E
INTRODUCTION
COLLEGE OF NURSING
Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor
in which the fetus shows signs of inadequate oxygenation (American Pregnancy Association). It is
characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.
If left untreated, fetal distress may result in the newborn breathing in meconium-containing
amniotic fluid (poo). This may make breathing difficult for them after delivery, or possibly cause them to
cease breathing entirely.
The most common cause of fetal distress is when the fetus does not get enough oxygen due to
placental abnormalities (such as placental abruption or placental insufficiency) or umbilical cord
abnormalities (for example, if the cord gets compressed because it comes out of the cervix first).
Distress in the fetus may also arise as a result of the mother's medical condition, such as diabetes,
renal illness, or cholestasis (a condition that affects the liver in pregnancy). It is more likely to occur if the
pregnancy is prolonged or if there are additional difficulties during labor. Occasionally, this occurs as a
result of very intense or frequent contractions. While fetal distress may occur at any moment throughout
pregnancy, it is more prevalent during labor.
The condition is detected most often with electronic fetal heart rate (FHR) monitoring through
cardiotocography (CTG), which allows clinicians to measure changes in the fetal cardiac response to
declining oxygen.
ANTEPARTUM INTERVENTIONS
Manage the fetal distress
COLLEGE OF NURSING
 The first step is usually to give the mother oxygen and fluids, as ordered. Re-oxygenation or the
reintroduction of oxygen to the baby by giving oxygen to the mother. This will allow re-perfusion
to the uterus.
 Sometimes, moving position, such as turning onto one side, can reduce the baby’s distress. Lower
the head of the bed and turn the mom on her left side to take the pressure off the vena cava and
allow blood flow to the heart and to the lungs.
 Stop any medications/ drugs that speed up labor as ordered, if there are signs of fetal distress. If
it’s a natural labour, then you may be given medication to slow down the contractions as
prescribed by the physician.

Give supportive care throughout labour
Communication
 Explain all procedures, seek permission, and discuss findings with the woman.
 Keep her informed about the progress of labour.
 Praise her, encourage and reassure her that things are going well.
 Ensure and respect privacy during examinations and discussions.
Breathing technique
 Teach her to notice her normal breathing.
 Encourage her to breathe out more slowly, making a sighing noise, and to relax with each breath.
 If she feels dizzy, unwell, is feeling pins-and-needles (tingling) in her face, hands and feet,
encourage her to breathe more slowly.
 To prevent pushing at the end of first stage of labour, teach her to pant, to breathe with an open
mouth, to take in 2 short breaths followed by a long breath out.
 During delivery of the head, ask her not to push but to breathe steadily or to pant.
Pain and discomfort relief

 Suggest change of position.
 Encourage mobility, as comfortable for her.
 Administer terbutaline and fentanyl as ordered.
Preparation for Delivery. Prepare as follows:

 Prepare for a sterile area for delivery. Prepare for the equipment needed.
 Be calm and reassuring.
 Position the patient on her back and place a folded sheet or drape under her buttocks.
 Make an oxygen tank and suction available.
 Wash your hands thoroughly before you open the obstetrical kit.
 Put on sterile gloves. Drape the patient with four towels so that everything but the vaginal
opening is thoroughly covered. Assist in proper positioning of the patient.
 Encourage the mother to relax and take slow, deep breaths through her mouth.
 Reassure the mother and explain to her what you are doing as you go along.
COLLEGE OF NURSING
POST-PARTUM INTERVENTIONS
Postpartum hemorrhage nursing management

 Assess the amount of bleeding.
 Assess for signs of shock.
 Assess the maternal vital signs to establish baseline data.
 Assess the condition of the uterus.
 Administer medication to stimulate uterine contractions (oxytocin) as ordered.
 Manual massage of the uterus to stimulate uterine contractions
 Administer IV fluid, blood and blood products as ordered to prevent shock.
Advice on postpartum care

Advise and explain to the woman:
 To always have someone near her for the first 24 hours to respond to any change in her condition.
 The importance of washing to prevent infection of the mother and her baby:
 Wash hands before handling baby
 Wash perineum daily and after faecal excretion
 Change perineal pads every 4 to 6 hours, or more frequently if heavy lochia
 Wash used pads or dispose of them safely
Counsel on nutrition
 Advise the woman to eat a greater amount and variety of healthy foods, such as meat, fish, oils,
nuts, seeds, cereals, beans, vegetables, cheese, milk, to help her feel well and strong (give
examples of types of food and how much to eat).
 Reassure the mother that she can eat any normal foods – these will not harm the breastfeeding
baby.
 Talk to family members to encourage them to help ensure the woman eats enough and avoids
hard physical work.
Conduct health education on proper breastfeeding.
Encourage follow-up care and referrals essential for recovery and rehabilitation after discharge.
Advise on danger signs

Advise to go to a hospital or health centre immediately, day or night, WITHOUT WAITING, if any of the
following signs:
 vaginal bleeding:
 more than 2 or 3 pads soaked in 20-30 minutes after delivery OR
 Bleeding increases rather than decreases after delivery.
 Convulsions.
 Fast or difficult breathing.
 Fever and too weak to get out of bed.
COLLEGE OF NURSING
 Severe abdominal pain.
 Calf pain, redness or swelling, shortness of breath or chest pain.
HEALTH ASSESSMENT
Part 1. Health History
Health History
A. Biographic Data
1. Name: Sheila Marie
2. Address: Philippines
3. Age: 15
4. Sex: Female
5. Race: Filipino
6. Religious orientation: Catholic
7. Health care financing and usual source of medical care: Parents
B. Chief Complaint
Excruciating Abdominal Pain
C. History of Present Illness

Visiting from Manila visiting sister and in complete denial of pregnancy. Parents and
sister are totally unaware she is pregnant. Because of her denial she has had no prenatal care. At
her sister’s home at 0100 she begins to experience strong abdominal cramps. She does not tell her
sister until 0700 and states she has a bad stomach ache. Her sister sees she is in a lot of pain and
immediately takes her to the nearest hospital.
Physical Assessment
A. Vital Signs
Date: February 14, 2022
Time: 7:00 am
Blood Pressure: 145/90 mmHg
Temperature: 99 °F
Pulse Rate: 102 bpm
Respiratory Rate: 28 bpm
Measurements:
Height: 5’2
Weight: 158 lbs
BMI: 28.9 (Overweight)
B. Review of Systems
COLLEGE OF NURSING
CNS Alert, oriented, cooperative, fearful

Cardiovascular Regular sinus rhythm, no gallops, rubs or murmurs, apical
clear, pulses +4 radial and pedal
Pulmonary Clear to A&P
Renal/Hepatic Voiding clear urine, no hepatomegaly felt
Gastrointestinal Distended, full term pregnancy
Endocrine Full term pregnancy
Heme/Coag No bruising or bleeding noted
Musculoskeletal Moves all extremities well. Spine within normal limits
Integument Clear without abrasions
Developmental History Normal Hispanic teenager
Psychiatric History None reported
Social History Sexually active, no reported drug, smoking or alcohol
history
COLLEGE OF NURSING
LABORATORY RESULTS/DIAGNOSTICS
Normal values
Na: 142 K: 4.2
Cl: 102 HCO3: 2622
Ca: 9.3 Mg: 1.2
Hgb: 13 Hct: 36.8
PT: 11.5 WBC: 5.2
Plt: 11.5 PTT: 25
VDRL: negative GBS: pending
Herpes: negative HIV: negative
Chlamydia: negative
COLLEGE OF NURSING
COLLEGE OF NURSING
PATHOPHYSIOLOGY
COLLEGE OF NURSING
Fetal Distress occurs due to inadequate supply of oxygen to the fetus. Oxygen is essential to obtain
energy to fuel the fetus’ growth. If these insufficient oxygenation is prolonged, anaerobic respiration will
occur to generate energy in the absence of oxygen. As a by-product of these process, lactic acid and
hydrogen ions are produced. Unlike carbon dioxide and water, which are by-products of aerobic
respiration, lactic acid and hydrogen ions builds-up faster than it could be burned-off.
With the build-up of hydrogen ions, it depresses the SA node of the heart, which serves as the
primary site for initiation of normal heartbeat (sinus rhythm), which then causes bradycardia and
deceleration. As there is decreased contraction of the heart, blood does not sufficiently travel throughout
the whole body causing reduced exchange of gases in the fetal blood. This causes accumulation of carbon
dioxide leading to respiratory acidosis.
Furthermore, the accumulation of lactic acid and hydrogen ions causes deficiency of bicarbonate
ions, which acts as a buffer against pH changes. A low level of bicarbonate ions cause metabolic acidosis.
Also, the increased acidity in the blood alters cardiac ion channel function and can predispose the heart to
develop an irregular heartbeat patterns.
Parasympathetic stimulation causes relaxation of anal sphincter and increased gastrointestinal
peristalsis which leads to passage of meconium.
If left untreated, respiratory and metabolic acidosis can cause cellular damage which can lead to
permanent disability or death.
COLLEGE OF NURSING
DRUG STUDY
Terbutaline
Classification Dosage Brand- Action Contraindications Indications Adverse Reactions Nursing Responsibilities
Generic
Name
Beta agonist; Adults and Brand Relaxes Hypersensitivity to Bronchospasm in CNS: Tremors, Assess:
Bronchodilator children Name: bronchial sympathomimetics, patients with anxiety, insomnia,  Respiratory function:
age 12 and Brethine smooth muscle narrow-angle reversible headache, dizziness, vital capacity, forced
older: by stimulating glaucoma, obstructive airway stimulation expiratory volume,
0.25 mg Generic beta receptors tachydysrhythmias disease ABGs, B/P, pulse,
may be Name: CV: Palpitations, respiratory pattern,
repeated in Terbutaline Effects on tachycardia, lung sounds
15 to 30 laboratory test hypertension,  Tolerance for long-
minutes, result: may dysrhythmias, cardiac term therapy, dose
p.r.n. decrease potassium arrest may be changed;
level monitor for rebound
Route: SQ GI: Nausea, vomiting bronchospasm
Metabolic:  Give S.C. injections

Hypokalemia in lateral deltoid area
 Protect medication
Respiratory: from light. Do not use
Paradoxical if discolored
bronchospam with
prolonged use, Safety alert:
dyspnea  Parodoxical
bronchospasm:
Skin: Diaphoresis dyspnea, wheezing,
keep emergency
equipment nearby
 Labor: maternal heart
COLLEGE OF NURSING
rate, B/P, contraction,
fetal heart rate
Administer:
 with food or may be
crushed, 2-hour
before bedtime to
avoid sleeplessness
Evaluate:
 therapeutic response,
absence of dyspnea,
wheezing
Teach patient/ family:

 To take medicine on
time; if missed, do
not makeup after 1 hr;
wait until next dose
 Make sure patient and
caregiver understand
why patient needs
drug
 Remind patient to
seperate oral doses by
6 hour interval
Treatment of overdose:
administer an alpha-blocker,
then norepinephrine for
severe hypotension
COLLEGE OF NURSING
Fentanyl
Classification Dosage Brand- Action Contraindications Indications Adverse Reactions Nursing Responsibilities
Generic
Name
Opioid 50 mcg – Brand Inhibits Hypersensitivity to For relief of severe CNS: Dizziness,  For better analgesic
Analgesic 100 mcg name: ascending pain opiates ongoing pain. May delirium, euphoria effect, give drug
Duragesic pathway in be used as a before patient has
Route: IV CNS, increase nutritional CV: Bradycardia, intense pain.
Generic pain threshold, supplement or to arrest, hypotension or  High dose can
name: treat hypocalcemia. hypertension produce muscle
Fentanyl rigidity so administer
Effect on EENT: Blurred the medicine by IV
Laboratory Test vision, miosis and give it slowly to
result: may prevent rigidity.
increase amylase GI: Nausea, vomiting  Monitor circulatory
and lipase levels and respiratory status
GU: urinary retention and urinary function
carefully. Drug may
Integumentary: rash, cause respiratory
diaphoresis depression, urinary
retention,
MS: Muscle rigidity hypotension, nausea,
vomiting, altered
RESP: Respiratory LOC.
depression,arrest  Periodically,
monitory
postoperative vital
signs and bladder
function. Because
drug decreases both
rate and depth of
respiration,
COLLEGE OF NURSING
monitoring arterial
oxygen saturation
may help assess
respiratory
depression,
 Immediately report
respiratory rate below
12 bpm, decreased
respiratory volume or
decreased SaO2.
Teach patient or family:

 When drug is used for
pain control, instruct
patient to request
drug before pain
become intense.
Physiological Nursing Diagnosis #1

COLLEGE OF NURSING
Name of Patient: Sheila Marie
Diagnosis or Clinical Impression: Fetal Distress
Assessment/Cues Nursing Background Goals and Objectives Nursing Evaluation

Diagnosis Knowledge Interventions and
Rationale
After 15 minutes
of nursing
Objective Ineffective Pregnancy-induced After 15 minutes of Independent
interventions,
tissue perfusion hypertension (PIH) nursing interventions,
BREATHING
related to is a form of high
Elevated blood vasoconstrictio blood pressure in Promote bed rest in a
 The
pressure (145/90 n of blood pregnancy. With  The patient must recumbent position to
patient’s
mmHg) vessels high blood exhibit a normal aid in the secretion of
blood
pressure, there is an blood pressure sodium.
Shortness of breath pressure is
increase in the  The patient SOB
(28 bpm)  Sodium normal
resistance of blood must be relieved
vessels. This may increases blood  The
Decreased  The client will
hinder blood flow pressure patient’s
FHR/Decelerations be free of
in many different SOB is
(indicate value) decelerations
organ systems in relieved
the expectant Keep the patient warm  FHR is
mother including normal
 To promote
the liver, kidneys, vasodilation
brain, uterus, and
placenta. Indicate values
COLLEGE OF NURSING
Elevate patient’s feet
 To reduce
blood pressure
through gravity
Encourage patient to
rest on left side
 To prevent
compression of
vena cava
Monitor blood
pressure and FHR
Dependent
Administers oxygen as
prescribed
 To increase
blood oxygen
COLLEGE OF NURSING
levels
Administers
medication as
prescribed
(Terbutaline)
 To relax
airways,
making it
easier to
breathe.
COLLEGE OF NURSING
ABC
Physiological Nursing Diagnosis #2
Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

Knowledge Objectives Interventions and
Rationale
Subjective Acute pain related Labor pain is After 30 minutes Independent After 30 minutes
to uterine generated by of nursing of nursing
contractions contractions of the interventions, the interventions, the
Patient states that she uterus's muscles and patient will be Educate the client patient,
has a bad stomach pressure on the able to: on pain distractions
ache cervix. This like deep breathing,
discomfort manifests visual imagery, and  Verbalize
as severe abdominal
make an
relaxation d
Objective cramps, groin pain, techniques reduction
and back pain, as of pain
well as an achy
sensation.
informe  These non-
pharmacolo
(pain
Guarding behaviour scale of
(+) Facial grimace

d gic comfort
measures
2/10)
 Appears
work by
Restlessness
decision providing
to be
relaxed
COLLEGE OF NURSING
regardin
Diaphoresis diversion between
uterine
Increased HR (102
contractio
bpm)
g Provide massage
and/or counter
ns
Pain scale of 9/10 Was able
pressure and/or
pain assist patient to find
position of
to use
appropriat
control maximum comfort

e
technique
options  Changing
positions
s to
enhance
and using comfort
she counter
pressure
and
maintain
would may help
alleviate
control of
labor
like to discomfort
caused by
process
(Focused
use pressure of
presenting
breathing,
Visualizat
parts on ion,
make an bony
structures,
Guided
imagery,
informe ligaments,
or tissue.
and
Change in
d Massage
helps
positions.
Relaxatio
COLLEGE OF NURSING
decision
relieve n through
muscle music)
tension.
regardin
g Provide positive
reinforcement and
pain encouragement to
patient
control  Gives sense

of control
options and self-
confidence
she
would
Dependent
like to Provide
information about
use available
analgesics, usual
 Verbalize responses/side
reduction effects (client and
of pain fetal), and duration
 Appear of analgesic effect
relaxed in light of current
COLLEGE OF NURSING
and be able situation.
to rest
 Providing
between
information
uterine
allows the
contraction
patient to
s
make
 Will be
informed
able to use
decisions
appropriate
regarding
techniques
pain control
to enhance
comfort
and
Administer pain
maintain
medications as
control of
ordered (Fentanyl)
labor
process  Fentanyl
stimulates
mu-opioid
receptors in
the central
nervous
system
(CNS),
altering the
body's
response to
COLLEGE OF NURSING
pain.
COLLEGE OF NURSING
Psychological Nursing Diagnosis #3
Remake
Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

Knowledge Objectives Interventions and
Rationale
Subjective Ineffective Ineffective After __ of nursing Independent After hour of

childbearing childbearing interventions, nursing
process related to process happens interventions, the
 The patient
Denial of pregnancy insufficient when the Ascertain the client’s patient was able
will be able
leading to lack of cognitive readiness pregnancy and understanding and to demonstrated
to
prenatal check up for parenting childbirth process expectation of the cooperation and
demonstrate
and care of the labor process and understanding of
cooperation
newborn that does who will participate the delivery
and
Objective not match the or provide support. process.
understandin
environmental (explain to the
g of the labor
context, norms patient, ask gaano
and delivery
Inappropriate and expectations. kadalas yung
process
response to onset of contraction, and
labor; decrease in yung characteristic
proactivity during ng contractions) Iba
labor and delivery. iba ang intervention
COLLEGE OF NURSING
Inadequate prenatal per stage of labor
care
 The client’s
Insufficient access of coping skills
support system are more
challenged
during the
active and
transitional
phases as
contractions
become
increasingly
intense. Lack
of
knowledge,
misconceptio
ns, or
unrealistic
expectations
can have a
negative
impact on
coping
abilities.
(1) Develop nurse-

COLLEGE OF NURSING
client relationship
and maintain an
open attitude toward
beliefs of the client.
 Acceptance
is important
to developing
and
maintaining a
relationship
and
supporting
independence
.
Engages patient and
family in plan of
care, calmly
reinforcing that
patient is in active
labor.
Monitor labor
progress and
maternal and fetal
well-being per
COLLEGE OF NURSING
protocol. Provide
continuous
intrapartal
professional support.
 Fear of
abandonment
can intensify
as labor
progresses
and client
may
experience
increased
anxiety and
loss of
control when
left
unattended.
LMP
Leopold’s maneuver
COLLEGE OF NURSING
REFERENCE
Mary, & Kabembo. (2019, May 31). 36 labor stages, induced and augmented labor nursing care
plans. Nurseslabs. Retrieved February 15, 2022, from https://nurseslabs.com/labor-stages-
labor-induced-nursing-care-plan/3/#c1
Fetal distress. Pregnancy Birth and Baby. (n.d.). Retrieved February 15, 2022, from
https://www.pregnancybirthbaby.org.au/fetal-distress#:~:text=The%20most%20common
%20cause%20of,out%20of%20the%20cervix%20first).
Pregnancy induced hypertension: Nursing Care Management. Nurseslabs. Retrieved February

15, 2022, from https://nurseslabs.com/pregnancy-induced-hypertension/
Pregnancy induced hypertension. Pregnancy induced hypertension | Children's Wisconsin. (n.d.).

Retrieved February 15, 2022, from https://childrenswi.org/medical-care/fetal-concerns-
center/conditions/pregnancy-complications/pregnancy-induced-hypertension#:~:text=Why
%20is%20pregnancy%2Dinduced%20hypertension,brain%2C%20uterus%2C%20and
%20placenta.
(1970, January 1). Fetal distress. Pathophysiology. Retrieved February 15, 2022, from
http://pathophysiology-tlc.blogspot.com/2011/06/fetal-distress-pathophysiology.html
U.S. National Library of Medicine. (n.d.). Meconium aspiration syndrome: Medlineplus medical
encyclopedia. MedlinePlus. Retrieved February 15, 2022, from
https://medlineplus.gov/ency/article/001596.htm
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University of Saint Louis

Tuguegarao City, Cagayan 3500

Lim, Cielo Rose

Pain and discomfort relief

Preparation for Delivery. Prepare as follows:

Postpartum hemorrhage nursing management

Advice on postpartum care

Conduct health education on proper breastfeeding.

Advise on danger signs

C. History of Present Illness

CNS Alert, oriented, cooperative, fearful

Metabolic:  Give S.C. injections

Teach patient/ family:

Teach patient or family:

Physiological Nursing Diagnosis #1

Assessment/Cues Nursing Background Goals and Objectives Nursing Evaluation

Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

(+) Facial grimace

control maximum comfort

control  Gives sense

Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

Subjective Ineffective Ineffective After __ of nursing Independent After hour of

(1) Develop nurse-

Pregnancy induced hypertension: Nursing Care Management. Nurseslabs. Retrieved February

Pregnancy induced hypertension. Pregnancy induced hypertension | Children's Wisconsin. (n.d.).

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