The scenario can be as simple or complex as you choose. Data is provided and
suggestions are given. You can begin and stop the scenario at multiple points
and discuss possible care and conclusions during debriefing.

Shana is a 26 year old with 2 children (ages 4 and 7). She is currently expecting her third child.
Shana’s boyfriend, of 2 years, left Shana after finding out she was pregnant. She is currently
living with her sister, Kyana.

Kyana is a single parent of 2 children, ages 3 and 5. Shana and her sister, Kyana are very close
and have combined resources to make their lives easier. Shana cares for the children and
maintains things at home while Kyana works.

Assessment Data on first prenatal visit:

26 year old African American

G3P2

107/84, 98.9, 82, 18

Weight: 180 lbs

Lab data: Urine negative for sugar and protein; Hgb-12 and Hct-34.

O+ Rubella +

HIV negative

Immunizations are up to date.
Shana comes to the office with complaints of a headache that won’t go away.

Assessments in office:

32 weeks gestation

FHR 130s-140s

162/110 98.8, 90, 26

Gained 7 lbs in last 2 weeks

Legs, feet and hands are puffy

Denies seeing spots or stars, but does admit to having blurred vision from time to time.

Reflexes are 3+ and negative for clonus

Protein in urine is 3+
Shana is sent to the hospital, placed in a room and assessed.

Admission Assessments:

BP 192/112, T 98.6, HR 102, RR 24

Denies pain or contractions
(Could have Shana starting to feel contractions)

FHTs - 130’s to 140’s

3+ Reflexes with Negative clonus

Urine 3+ protein

Vaginal exam revealed 2 cm dilated, 50% effaced with membranes intact.
Would like student to have Shana lay on her left side and decrease stimuli.

Dr. Orders

Bedrest

Stat labs (magnesium, calcium, CBC, Liver and renal panel)

Magnesium sulfate 4 gm bolus now and continue per protocol at 2 gms per hour.

IV of LR at 50cc per hour

Continuous fetal monitoring
Shana could go into labor on her own or begin Pitocin. You could also choose
to administer Betamethasone or not.
6 hours later Shana’s assessment findings are:

BP 188/98, T 98.6, HR 102, R 16 pain (6)

Vaginal exam reveals 4 cm and 90% effaced at zero station. Contractions are firm every 3-4
minutes lasting 40-90 seconds.

Membranes were ruptured by healthcare provider with clear fluid noted.

Reflexes 3+ with negative clonus

Shana is now asking for something for pain

Shana was given an epidural for pain management and complained of an urge to push during
insertion.

Vaginal examination reveals

10 cm

0/+1 station

100% effaced
Shana is ready for a vaginal delivery and needed healthcare personnel and equipment are called and
collected.
Shana delivers a female infant with mild respiratory depression.
You could go through the delivery process and the newborn and/or maternal
postpartum assessments.