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Shoulder Dystocia
Shoulder Dystocia
A Case of:
SHOULDER DYSTOCIA
Submitted by:
Soriao, Lovely Rose V.
BSN 4C (Group 2)
Submitted to:
Janette S. Garcia, RN
Clinical Instructor
SCENARIO 7:
I. DEMOGRAPHIC PROFILE
Name: Laura
Age: 32-year-old
Gender: Female
Nationality: Filipino
Civil Status: Married
Date of Birth: February 1, 1990
Religion: Roman Catholic
Admitting Physician: Dra. Ob
Date of Admission: October 9, 2023
Room No: 210
● Patient’s blood glucose result was 180 mg/dl. She was diagnosed with
gestational diabetes at 26 weeks and was prescribed Metformin 500 mg
PO TID. An ultrasound was done two weeks ago (at 37 weeks.) because
her fundic height was 36 cm. Her ultrasound result showed that the
estimated fetal weight was 35000 grams. Upon internal examination the
patient presents the following findings
Vital Signs:
● Blood Pressure: 140/90 mmHg
● Pulse Rate: 100bpm
● Respiratory Rate: 21cpm
● Temperature: 36.7
● Oxygen Saturation: 96%
Inspection and Head and EYES - Visual acuity AS, PPC, no Anicteric sclera
Palpation Hair is intact; sclera is CLADS means that the white
non-icteric. part of your eye is
Conjunctivae are white and healthy in
clear without appearance.
exudates. No signs of
nystagmus. Posterior polar
cataract (PPC) is a
THROAT/MOUTH - unique form of
Oral mucosa is pink congenital cataract,
and moist with good which results in
dentition. No buccal defective distance
nodules or lesions and near vision and
noted. affects the patient's
daily activities.
No rales, rhonchi,
wheezes, or rubs.
Vocal and tactile
fremitus normal.
IV. LABORATORY/DIAGNOSTICS
ULTRASONOGRAPHY RESULT:
Impression: Single, Live uterine pregnancy with normal and regular cardiac activity
Presentation: Cephalic
Amniotic Fluid: Normal
Fetal Movements: Present
Fetal Weight: 3500 grams
Gestational Age: 37 weeks
Fetal Heart Rate: 140 beats/minute
V. MEDICAL INTERVENTION (DRUG STUDY)
METFORMIN Biguanide oral Metformin is a ● Severe renal Lactic acidosis, Do not use with
hyperglycemic medication impairment a serious and renal
Classification: agent. Unlike used to control or elevated potentially fatal dysfunction,
Hormones & sulfonylureas, blood glucose serum condition metabolic
Synthetic biguanides do levels in creatinine caused by the acidosis, or
Substitutes; not stimulate the people who levels buildup of lactic ketoacidosis.
antidiabetic release of the have type 2 ● Hypersensiti acid in the
agent; insulin from the diabetes. It is vity or blood Monitor urine or
Biguanides beta cells of the sometimes allergy to Low blood serum glucose
pancreas. used together metformin sugar, which levels frequently
Route: Oral Mechanism of with insulin or ● Acute or can cause to determine
action is thought other chronic symptoms such effectiveness of
Dosage: to be due to medications, metabolic as dizziness, drug and
500mg tab both increasing but it is not for acidosis, sweating, dosage.
the binding of treating type 1 including hunger, and
Frequency: insulin to its diabetes. diabetic confusion.
TID receptor and Unlike insulin, ketoacidosis
potentiating metformin ● Congestive
insulin action. doesn't cause heart failure
weight gain requiring
and may help pharmacolog
with weight ic treatment
loss.
VIII. PATHOPHYSIOLOGY
Etiology
Shoulder dystocia is associated with advanced maternal age, diabetes maternal
obesity, large baby (macrosomia), postdate pregnancy, and multiparity.
Pathophysiology
Shoulder dystocia results from a size discrepancy between the fetal shoulders
and the pelvic inlet. In normal labor, after internal rotation, the biparietal diameter
rests in a transverse position with the bisacromial diameter in an oblique angle.
Extension and restitution result in the occiput returning to the anteroposterior
plane. It is speculated that a persistent anteroposterior location of the fetal
shoulders at the pelvic brim occurs when there is increased resistance between
the fetal skin and vaginal walls (e.g., with macrosomia), with a large fetal chest
relative to the biparietal diameter, and when truncal rotation does not occur (e.g.
precipitous labor). When this occurs, the anterior shoulder impacts behind the
symphysis pubis. Shoulder dystocia also may occur from impaction of the
posterior fetal shoulder on the maternal sacral promontory.
IX. NURSING CARE PLANS
4. To encourage
the baby’s
shoulder to change
position and rotate.
COLLABORATIVE
SUBJECTIVE: Risk for fetal Within 15-30 1. Establish 1. This will help After 15-30
and maternal minutes of rapport with the in performing the minutes of
“Masakit ang injury related to nursing patient. following nursing
tiyan ko ” as Cephalopelvic interventions, interventions interventions,
verbalized by Disproportion the mother 2. Assess fetal more easily. the mother
the patient. (CPD) will heart rate. Count successfully
successfully for 10 minutes, 2. Continue this delivered the
OBJECTIVE deliver the break for 5 pattern baby and
DATA: baby and will minutes, and throughout the does not
not count again for 10 contraction. This experience
BP: 140/90 experience minutes. detects any health
mmHg any health abnormal complications;
PR: 100bpm complications 3. Assist in responses which and the baby
RR: 21cpm ; and the performing may be caused is free of
T: 36.7 baby will be episiotomy. by stress, trauma, injury,
O2: 96% free of hypoxia, and other
trauma, 4. Assist the acidosis, or complications
injury, and mother in the sepsis. and has
other position of displayed
complications McRoberts’ 3. An episiotomy normal fetal
and will maneuver prevents tearing heart rate with
display and opens the no late
normal fetal birth canal to decelerations
heart rate allow more room noted.
with no late for the baby to
decelerations pass through.
noted
4. This
maneuver is a
position in which
the mother is
lying on her back
with her legs
pushed towards
her tummy. This
can help widen
the birth canal
X. DISCHARGE PLAN